Abstract 17107: Late Distal Luminal Gain After Percutaneous Coronary Intervention For Chronic Total Occlusion: Relationship With Myocardial Viability
INTRODUCTION: In chronic total occlusions (CTO), vascular function at the distal bed often remains impaired after percutaneous coronary intervention (PCI) and does not recover until mid-term follow-up (FU), contrary to what happens in acute coronary occlusions. To clarify this fact and to investigate if the presence of myocardial viability may be a determinant of late distal luminal gain, we have prospectively analyzed 15 consecutive patients with successful PCI of CTO between 2010 and 2011.
METHODS: A cardiac MRI was performed in all cases prior to PCI. Segments with delayed gadolinium enhancement >50% of wall thickness were considered as non-viable. The minimal, maximal and mean luminal diameters and areas were measured by one blinded observer for the segment 10-25 mm distal to the last stent immediately after PCI (post-procedure) and at FU (6 months after PCI) using offline quantitative coronary angiography (QCA) analysis.
RESULTS: Globally, we found a significant increase in minimal diameter (1.03±0.5mm vs 1.32±0.7mm, p=0.01), mean diameter (1.58±0.6mm vs 1.74±0.7mm, p=0.04) and mean luminal area (2.33±1.6mm2 vs 2.82±2.0mm2, p=0.01) at FU. In all cases with viability an increase in distal vessel diameter was observed at FU. However, in patients without viability either the distal vessel decreased or remained unchanged 6 months after PCI.
CONCLUSION: Late distal luminal gain was observed after PCI of CTO in patients with viability. This finding has technical implications for appropriate stent sizing as well as physiopathological considerations. Myocardial viability as assessed by cardiac MRI is associated with recovery of vascular function in the distal bed of a CTO.
- © 2012 by American Heart Association, Inc.