Dual-Source-CT coronary angiography for predicting success of revascularization in chronic total occlusions

Objective. 25 consecutive patients underwent cardiac CT between November 2009 and September 2012 to evaluate configuration of chronic total occlusion (CTO) of a coronary artery to assess eligibility of percutaneous recanalization. Material and methods. Between 11/2009 and 06/2014 25 consecutive patients underwent DSCT-CA for evaluation of CTO. Technical success and complication rate of revascularization procedures were documented. For image analysis the datasets of 12 parameters were used to calculate CTO-try score. By calibration to the study cohort the AC-CTO-try and simplified CTO-try score were constructed respectively and compared to J-CTO by the area under the ROC-curve. Results. 88% of CTOs involved the right coronary artery (RCA) with a mean length of 4.6 ± 2.7 cm. 68% (17/25) were stratified as difficult or very difficult CTO-segments by J-CTO. Based on CTO-try an intervention was recommended in 9/25 patients, while revascularization was attempted in 16/25 (64%) patients with a success rate of 56% (n = 9/16). Negative predictive value for revascularization failure was 75%. By using sCTOtry, discrimination between success and failure of the intervention was measured with an AROC = 0.892. Conclusions. DSCT-CA permits visualization of the occluded vessel segment and provides a tool for assessing the probability of revascularization failure based on the CTO-try score. SCTOtry, calibrated to our cohort and expertise, can be used for predicting success of recanalization attempt.

coronary arteries, computed tomography angiography, total occlusion

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