Abstract 11677: Impact of Multislice Computed Tomography in Evaluating Micro-Channels in Coronary Chronic Total Occlusion Lesions Prior to Percutaneous Coronary Intervention
Background: Although the recanalization of chronic total occlusion (CTO) lesions in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures, a recently developed hydrophilic floppy wire can allow us to cross the CTO lesion without any complicated techniques. Multi-slice computed tomographic coronary angiography (CTCA) provides noninvasive evaluation of the coronary artery by visualizing vessel trajectory and morphological features at the occluded site. The aim of this study was to evaluate the value of CTCA in predicting the micro channels most likely to achieve successful guidewire crossing prior to CTO PCI.
Methods: We performed CTCA in patients with CTOs (of > 3 months' duration); 187 lesions were scanned. Patients were divided into 2 groups: (1) successful wire crossing with a single soft wire (Single group) and (2) successful wire crossing with complicated techniques or failed crossing attempts (Control group). Morphological parameters between the 2 groups were compared.
Results: Successful wiring with a single soft wire using the antegrade approach was achieved in 111 lesions (59.4%). Compared to the Control group, the Single group had more micro contrast infiltration and less stump morphology at the distal end (Table).
Conclusions: Micro contrast Infiltration at the occluded portion and stump morphology (distal) on CTCA are significant predictors for successful wiring with a single soft wire. These findings indicate that CTCA could provide practical information to determine the outcomes of CTO-PCI.
- © 2011 by American Heart Association, Inc.