The role of imaging in coronary chronic total occlusion intervention

Summary

Chronic total occlusion intervention (CTO PCI) has been maturing with the advent of dedicated equipment. Simultaneously coronary Imaging modalities have evolved rapidly over the decades, application of the technologies are more demanding, as the current daily practice in CTO PCI becomes more complicated. Non-invasive imaging is central to the evaluation of ischaemia and myocardial viability which are pre-requisites for the selection of appropriate patients for CTO-PCI. In addition, computed tomographic coronary angiography can evaluate anatomical features not apparent on conventional invasive angiography as well as predict the complexity and likely success of guidewire passage during PCI. During CTO PCI intravascular ultrasound has been used increasingly to improve the quality of intervention particularly in the presence of complex anatomy.

Nuclear Test

Single Photon Emission Computed Tomography (SPECT) is used for assessing the extent of ischemia and the presence of viability of the CTO region 11. Maes AF, Borgers M, Flameng W et al. Assessment of myocardial viability in chronic coronary artery disease using technetium99m sestamibi SPECT: correlation with histologic and positron emission tomographic studies and functional follow-up. J Am Coll Cardiol. 29(1), 62–68 (1997). Link. Localization of ischemia/viability is a strong point of SPECT, while Exercise Tolerance...