Coronary Computed Tomography Angiography Solving Ambiguity in Chronic Total Occlusion Percutaneous Coronary Intervention.
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SUBMITTER: Shekiladze N
PROVIDER: S-EPMC11308485 | biostudies-literature | 2024 Mar
REPOSITORIES: biostudies-literature
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Coronary Computed Tomography Angiography Solving Ambiguity in Chronic Total Occlusion Percutaneous Coronary Intervention.
Shekiladze Nikoloz N Ueyama Hiroki H Sandesara Pratik P Maisuradze Nodari N Gleason Patrick P Nicholson William J WJ
Journal of the Society for Cardiovascular Angiography & Interventions 20240326 3Part B
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Project description:Whereas coronary computed tomography angiography (CCTA) exceeds invasive angiography for predicting the procedural outcome of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), CCTA-derived scores have never been validated in the hybrid CTO PCI population. In this single-center, retrospective, observational study, we included 108 consecutive patients with 110 CTO lesions and preprocedural CCTA who underwent hybrid CTO PCI to assess the diagnostic accuracy of CCTA-derived scoring systems. Successful guidewire crossing within 30 min was set as the primary endpoint. The secondary endpoints were final procedural success and the need for using any non-antegrade wiring (AW) strategy within the hybrid algorithm. Time-efficient guidewire crossing and final procedural success were achieved in 53.6% and 89.1% of lesions, respectively, while in 36.4% of the procedures, any non-AW strategy was applied. The median J-CTO score was 1 (interquartile range (IQR): 0, 2), while the CT-RECTOR, KCCT, J-CTOCCTA, and RECHARGECCTA scores were 2 (IQR: 1, 3), 3 (IQR: 2, 5), 1 (IQR: 0, 3), and 2 (IQR: 1, 3), respectively. All scores were significantly higher in the lesions with failed versus successful time-efficient guidewire crossing. Although all of the CCTA-derived scores had numerically higher predictive values than the angiographic J-CTO score, no significant differences were noted between the scores in any of the analyzed study endpoints. High sensitivity of the CT-RECTOR and RECHARGECCTA scores (both 89.8%) for predicting successful guidewire crossing within 30 min, and high sensitivity (90.8%) of the KCCT score for predicting final procedural success, were noted. CCTA-derived scoring systems are accurate, noninvasive tools for the prediction of the procedural outcome of hybrid CTO PCI, and may aid in identifying the need for use of the hybrid algorithm.
| S-EPMC10817054 | biostudies-literature
Project description:BackgroundDue to the uncertainty of the success of percutaneous coronary intervention (PCI) and the complexity of selecting suitable treatment cases, the interventional outcome of coronary chronic total occlusion (CTO) remains challenging. The purpose of this study was to evaluate the role of quantitative plaque analysis based on coronary computed tomography angiography (CCTA) in predicting the CTO-PCI outcome.MethodsWe retrospectively included 78 patients with CTO (80 lesions) confirmed by invasive coronary angiography from July 2016 to December 2018. All patients underwent PCI treatment according to standard practice. A total of 47 lesions in 47 patients were successfully treated with PCI. PCI failed in the remaining 33 lesions in 31 patients. The following conventional CCTA morphologic parameters were evaluated and compared between the PCI-success and PCI-failure groups: stump morphology; occlusion length, tortuous course; CTO lesion calcium; bridging collateral vessel; retrograde collateral vessel; the appearance of the occluded distal segment; and quantitative CTO plaque characteristics, including total plaque volume, calcified plaque (CP) volume, noncalcified plaque (NCP) volume, low-density noncalcified plaque (LDNCP) volume, and plaque length. Univariate and multivariate logistic regression analyses were performed to determine independent parameters predictive of CTO-PCI outcomes. The predictive performances were assessed using receiver operating characteristic curve analysis.ResultsThe blunt stump was the only independent CCTA morphologic parameter to predict the outcome of CTO-PCI [odds ratio (OR): 10.807; P<0.001]. NCP volume (OR: 1.018; P<0.001), CP volume (OR: 1.026; P=0.049), and plaque length (OR: 1.058; P=0.037) were independent quantitative CTO plaque characteristics predictive of CTO-PCI outcomes. The plaque-based model combining NCP volume with CP volume and plaque length had a higher area under the curve (AUC =0.96) than did the morphology-based model that included blunt stump (AUC 0.68) in predicting the outcomes of CTO-PCI (P<0.001).ConclusionsThe CCTA-based plaque characteristics, including NCP volume, CP volume, and plaque length, outperformed morphologic parameters in predicting the CTO-PCI outcomes.
| S-EPMC10006140 | biostudies-literature
Project description:ObjectivesDifferentiating chronic total occlusion (CTO) from subtotal occlusion (SO) is often difficult to make from coronary computed tomography angiography (CCTA). We developed a CCTA-based radiomics model to differentiate CTO and SO.MethodsA total of 66 patients with SO underwent CCTA before invasive angiography and were matched to 66 patients with CTO. Comprehensive imaging analysis was conducted for all lesioned vessels, involving the automatic identification of the lumen within the occluded segment and extraction of 1,904 radiomics features. Radiomics models were then constructed to assess the discriminative value of these features in distinguishing CTO from SO. External validation of the model was performed using data from another medical center.ResultsCompared to SO patients, CTO patients had more blunt stumps (internal: 53/66 (80.3%) vs. 39/66 (59.1%); external: 36/50 (72.0%) vs. 20/50 (40.0%), both p < 0.01), longer lesion length (internal: median length 15.4 mm[IQR: 10.4-22.3 mm] vs. 8.7 mm[IQR: 4.9-12.6 mm]; external:11.8 mm[IQR: 6.1-23.4 mm] vs. 6.2 mm[IQR: 3.5-9.1 mm]; both p < 0.001). Sixteen unique radiomics features were identified after the least absolute shrinkage and selection operator regression. When added to the combined model including imaging features, radiomics features provided increased value for distinguishing CTO from SO (AUC, internal: 0.772 vs. 0.846; p = 0.023; external: 0.718 vs. 0.781, p = 0.146).ConclusionsThe occluded segment vessels of CTO and SO have different radiomics signatures. The combined application of radiomics features and imaging features based on CCTA extraction can enhance diagnostic confidence.
| S-EPMC11005149 | biostudies-literature
Project description:Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): -0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: -0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.
| S-EPMC8452917 | biostudies-literature
Project description:BackgroundContemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) incorporates wire escalation and dissection/re-entry recanalisation strategies.AimsThe purpose of the study was to investigate changes in collateral function after CTO PCI and to identify whether the mode of successful recanalisation influences collateral function regression.MethodsPatients scheduled for elective CTO PCI with evidence of viability in the CTO territory by noninvasive imaging were included in this study. After successful CTO PCI, the aortic pressure (Pa) and distal coronary artery wedge pressure (Pw) during balloon occlusion were measured, both in a resting state and during infusion of intravenous adenosine, allowing the calculation of the pressure-derived collateral pressure index at rest and hyperaemia (CPIrest and the collateral fractional flow reserve [FFRcoll], respectively). Measurements were repeated 3 months later during angiographic follow-up.ResultsEighty-one patients had physiological measurements at baseline and follow-up. In the final cohort the mean age was 64 years and 82% were male. The mean maximal stent diameter and total stent length were 3.2±0.5 mm and 68±31 mm, respectively. Successful strategies were antegrade wiring (64.2%), antegrade dissection re-entry (8.6%), and retrograde dissection re-entry (27.1%). Between the index procedure and follow-up, wedge pressure decreased from 34±11 mmHg to 21±8.5 mmHg (p<0.01), respectively. FFRcoll changed from 0.34±0.11 to 0.19±0.09 (p<0.01) at follow-up and CPIrest from 0.40±0.14 to 0.17±0.09 (p<0.01). Absolute maximum collateral flow decreased from 55±32 ml/min directly after PCI to 38±24 ml/min (p<0.01). There was no relation between the recanalisation technique and changes in FFRcoll.ConclusionsThere was a significant reduction in collateral flow over time, independent of the recanalisation technique.
| S-EPMC9743238 | biostudies-literature
Project description:Computed tomography angiography (CTA) has played a significant role in evaluation of coronary artery disease in the last decade and has demonstrated high sensitivity and negative predictive values. However, the positive predictive value as compared with invasive fractional flow reserve (FFR) is limited. CT-FFR has emerged as a disruptive noninvasive technology with higher specificity and diagnostic accuracy for detection of hemodynamically significant coronary lesions as compared with invasive FFR than conventional coronary CTA. CT-FFR has been shown to be cost-effective as a gate-keeper to invasive coronary angiography and has the potential to limit unnecessary invasive angiography studies.
| S-EPMC6553476 | biostudies-literature
Project description:ObjectivesThis study evaluated myocardial viability as well as global and regional functional recovery after successful chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) using sequential quantitative cardiac magnetic resonance (CMR) imaging.BackgroundThe patient benefits of CTO PCI are being questioned.MethodsIn a single high-volume CTO PCI center patients were prospectively scheduled for CMR at baseline and 3 months after successful CTO PCI between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (<2.84 mm SWT) with no or limited scar (≤50% LGE).ResultsA total of 132 patients were included. Improvement of left ventricular ejection fraction was modest after CTO PCI (from 48.1 ± 11.8 to 49.5 ± 12.1%, p < 0.01). CTO segments with viability (N = 216, [31%]) demonstrated a significantly higher increase in SWT (0.80 ± 1.39 mm) compared to CTO segments with pre-procedural preserved function (N = 456 [65%], 0.07 ± 1.43 mm, p < 0.01) or extensive scar (LGE >50%, N = 26 [4%], -0.08 ± 1.09 mm, p < 0.01). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0-1 segment viability (0.49 ± 0.93 vs. 0.12 ± 0.98 mm, p = 0.03).ConclusionsDetection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability on CMR aids in identifying patients with significant regional functional recovery after CTO PCI.
| S-EPMC9291134 | biostudies-literature
Project description:BackgroundThe concept of three-dimensional (3D) wiring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is now widely accepted among coronary interventionalists. The 3 axes, i.e., the 2 X-ray beams and the CTO segment, should intersect with each other at as close to a right angle as possible. However, how to specify optimal fluoroscopic angulations for a given CTO segment has not been well established.AimsWe aimed to develop a simple and practical method to identify optimal fluoroscopic angulations for CTO PCI.MethodsA CTO vector can be derived from slab maximum intensity projection (MIP) images of coronary computed tomography (CT) angiography. Using trigonometric functions, the inner product of vectors and the equation of a plane, we calculated 2 fluoroscopic vectors perpendicular to each other and to the CTO vector.ResultsWe applied this method to a patient with mid-left circumflex CTO and translated the resulting fluoroscopic vectors into optimal fluoroscopic angulations. To facilitate its use, we developed a calculator using spreadsheet software that can output optimal fluoroscopic angulations within a practical range by inputting the x, y, and z components of the CTO vector. This approach also helps to minimise dead angles in biplane fluoroscopy.ConclusionsThis method has the potential to make CTO PCI safer and easier, without requiring dedicated equipment or software. Its effectiveness should be validated in clinical practice.
| S-EPMC10507606 | biostudies-literature
Project description:In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.
| S-EPMC10253845 | biostudies-literature
Project description:Percutaneous coronary intervention (PCI) in pediatric patients is rare, especially in cases of chronic total occlusion (CTO) of the left main coronary artery (LMCA), with scarce evidence. These are associated with poorer prognostic outcomes, highlighting the need for timely intervention. In addition, its unique and entirely different pathophysiology compared to that well-studied in adults makes it a clinically challenging scenario for diagnosis, treatment, and follow-up. Here, we present 2 unique cases of successful PCI for LMCA CTO in pediatric patients at our institution.
| S-EPMC11775790 | biostudies-literature