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TO lesions represent the last frontier for coronary interventionist and are still considered frequent reason for referring patients for CABG. CTO intervention is proven to be a complex procedure with a variable success rate between 55 and 80% in most experienced centers, high success rates are usually observed in a few luminary sites. This procedure results in different complications including dissection, perforation and impairment of ipsilateral collaterals to the distal bed. Also it is associated with a considerable rate of major adverse coronary event (MACE).
Due to the high complexity of CTO interventions and the potential of facing higher incidence of complications, the correct and accurate patient selection based on presence predicting success factors of the procedure must be done.
Different studies in the last few years were conducted aiming at identifying both pre-interventional and interventional parameters that are responsible for predicting success or failure of the complex procedure of CTO revascularization. These parameters were originally derived from different imaging modalities such as MSCT, CT and cardiac MRI.
MSCT is proven to be useful tool in optimizing PCI strategy as it gives the chance to characterize the course, occlusion length and composition of an occluded artery and also allow the visualization of the distal runoff and side branches.
In the current study, we studied whether multi detector computed tomography (MDCT) have an impact on the success rate of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) of right coronary artery (RCA).
The present study is a case control study which was conducted on 30 patients divided into two groups, each composed of 15 patients of all age groups and of both sexes, referred to Cardiology department at Ain Shams University Hospitals for PCI to CTO RCA during the period between August, 2017 and August, 2018.
group A: in whom multidetector computed tomography study was performed as routine workup before planned percutaneous coronary revascularization to CTO RCA.
group B: in whom percutaneous coronary revascularization to CTO RCA was done based on Coronary angiographic data only.
Patients with Irregular cardiac rhythms (atrial ﬁbrillation and frequent atrial/ventricular premature complexes), severe renal impairment (creatinine clearance less than 30 mL/min), Decompensated heart failure (NYHA class IIIb and IV) and non viable myocardium in the territory of CTO artery were excluded from the study.
All patients were subjected to proper history taking thorough clinical examination, ECG, echocardiography, serum creatinine measurement then adequate preparation before MSCT and PCI by good hydration. Proper assessment of the previously done CA was done then MSCT was conducted using a dual source machine with interpretation of all data regarding CTO segment and characters of the artery before and after it. PCI was then undergone by experienced CTO operators and all the procedure variables were registered. Patients were followed up for immediate post-procedural complications.
Comparison between MSCT and invasive CA (which is the gold standard for coronary details visualization) revealed that a significant increase in success in the patient group which had undergone pre-interventional coronary MSCT. The success outcome was 14 patients (93.3 %) and only 1 patient failed (6.7%). While the control group had 9 patients with successful outcome (60%) and 6 patients were failed (40%). The P-values equated to (0.03).
Finally out of the 30 patients finally studied (the group of patients which had undergone pre-interventional coronary CTA and non CT group) patients were classified by different method according to final outcome. Patients were classified into two main groups; group 1 which included successful procedures in 23 patients and group 2 which included failed procedures in 7 patients.
By comparing both groups the length of CTO segment was the only independent variable predicting the success (or failure) of the procedure.
Finally, the study concluded that MSCT could be utilized to plan PCI procedure upon coronary CTO and predicts its outcomes. It was proven that MSCT can be done prior to CTO intervention procedure especially with the rapidly developing technology that enables us to do it with minimal radiation exposure.