Abstract 4165: Three-Dimensional Volumetric Analysis of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography
Background: Despite of recent advancement of techniques and devices, percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is still challenging procedure. We hypothesized that 3-dimensional analysis of CTO plaque by multidetector computed tomography (MDCT) can identify the nature of CTO plaque such as exact vessel size, remodeling pattern, or hardness, which could not be measured by traditional coronary angiography, and helps to predict the success of PCI.
Methods and results: Preprocedural 64-row MDCT of 186 CTO lesions were enrolled in this prospective multicenter registry. Three-dimensional volumetric radiologic density analysis was performed. Plaque characteristics were determined by Hounsfield Unit (HU) of each image voxels using dedicated softwares. The overall PCI success rate was 77.4% (144/186). Negative remodeling was more common in old CTO, but was not related to PCI failure. Reattempt of previously failed cases and low volume of fibrofatty plaque in proximal segment of CTO were significant predictor of PCI failure by univariate analysis but not by multivariate analysis. The occlusion duration >12 month (OR=3.1, 95% CI=1.4 – 6.6, p=0.004), lesion length >18 mm (OR=2.8, 95% CI=1.2– 6.6, p=0.016), and focal radiologic density >139 HU (OR=2.8, 95% CI=1.2– 6.5, p=0.018) were independent predictors of PCI failure by multivariate analysis.
Conclusion: The procedural success of CTO PCI can be predicted by MDCT. In addition to the occlusion of duration and lesion length, high focal radiologic density in CTO lesion measured by MDCT was significant predictors of PCI failure.