Young Jin Kim MD, Abstract Co-Author: Nothing to Disclose

Jung Rae Cho MD, Abstract Co-Author: Nothing to Disclose

Ji Eun Nam MD, Abstract Co-Author: Nothing to Disclose

Byoung Wook Choi MD, Abstract Co-Author: Nothing to Disclose

Jin Huh MD, Presenter: Nothing to Disclose

Kyu Ok Choe MD, Abstract Co-Author: Nothing to Disclose

The main reason for the failure of PCI in CTO patients is due to calcification which hinder the passage of guide wires. MDCT can evaluate location and amount of calcium in occluded segments. We sought to evaluate MDCT-derived parameters which can affect procedural outcomes of coronary PCI in CTO patients.

A total of 38 patients (41 lesions) who had chronic total occlusion (duration >1 month) in conventional angiography were studied. All the patients underwent CT using a 64 MDCT (Somatom Sensation 64, Siemens, Germany) prior to PCI. The lesions were divided into two groups: Group I (PCI-success, 33 lesions) was defined as patients in which guide wires could be passed through the lesion, whereas group II (PCI-failure, 8 lesions) was defined as patients in which there were guide wire passage failures. The clinical characteristics, angiographic, and MDCT-derived parameters were evaluated.

Procedural success rate was 80.5% (33/41 lesions). There were no significant differences between the two groups in the following categories: age, male gender, hypertension, diabetes, smoking, history of myocardial infarction, presence of multi-vessel disease, and left-ventricular ejection fraction. The duration of CTO was shorter in group I than in group II (months, 5.94±2.0 vs 17.71±7.79, p=0.04) and history of prior PCI in the same occluded segment was less frequent in group I than in group II(12.5% vs 71.4%, p=0.0004). Derived parameters from 64-MDCT revealed that the calcium volume(mm3, 10.66±3.32 vs 74.33±25.60, p<0.0001), calcium equivalent mass (mgCaHA, 2.66±0.79 vs 18.83±6.73, p=0.0001), calcium score (13.72±4.28 vs 100.04±35.93, p=0.0001) in the occluded segments were greater in group II than in group I. Moreover, the length of the occluded segment was shorter in group I than in group II(mm, 20.98±3.33 vs 45.24±9.0, p=0.0058).

Utilization of MDCT images can accurately identify the route and length of the CTO segments and quantitatively evaluate the amount of the calcified plaque.

MDCT is a useful and reliable preprocedural tool to predict the procedural outcome of PCI in CTO patients.

Kim, Y, Cho, J, Nam, J, Choi, B, Huh, J, Choe, K, Clinical Impact of 64-MDCT on Percutaneous Coronary Intervention (PCI) of Chronic Total Occlusion (CTO).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5015865.html