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Insights into Imaging
Published in: Insights into Imaging 1/2024

Open Access 01-12-2024 | CT Angiography | Critical Review

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Authors: Wei Xu, Junfeng Ma, Yiwen Chen, Fan Zhou, Changsheng Zhou, Long Jiang Zhang

Published in: Insights into Imaging | Issue 1/2024

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Abstract

Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists.
Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies.
Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low.
• Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion.
• The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI.
• The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions.
• After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency.

Graphical Abstract

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Metadata
Title
Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?
Authors
Wei Xu
Junfeng Ma
Yiwen Chen
Fan Zhou
Changsheng Zhou
Long Jiang Zhang
Publication date
01-12-2024
Publisher
Springer Vienna
Keyword
CT Angiography
Published in
Insights into Imaging / Issue 1/2024
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-024-01621-y

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