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Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 7/2015

Open Access 01-07-2015 | Cardiac Computed Tomography (TC Villines, Section Editor)

Value of Hybrid Imaging with PET/CT to Guide Percutaneous Revascularization of Chronic Total Coronary Occlusion

Authors: Wijnand J. Stuijfzand, Pieter G. Raijmakers, Roel S. Driessen, Niels van Royen, Alexander Nap, Albert C. van Rossum, Paul Knaapen

Published in: Current Cardiovascular Imaging Reports | Issue 7/2015

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Abstract

Chronic total coronary occlusions (CTO) are documented in approximately one fifth of diagnostic invasive coronary angiographies (ICA). Percutaneous coronary interventions (PCI) of CTO are challenging and are accompanied by higher complication and lower success rates in comparison with non-CTO PCI. Scrutinous evaluation of ischemia and viability to justify percutaneous revascularization is therefore of importance to select eligible patients for such a procedure. Furthermore, knowledge of the anatomical features of the occlusion may predict the chances of success of PCI CTO and could even guide the procedural strategy to augment the likelihood of recanalization. Positron emission tomography (PET) is unequivocally accepted as the reference standard for ischemia and viability testing, whereas coronary computed tomography angiography (CCTA) currently allows for non-invasive detailed three-dimensional imaging of the coronary anatomy that adds morphological information over two-dimensional ICA. Hybrid PET/CT could therefore be useful for optimal patient selection as well as procedural planning. This review discusses the potential value of PET/CT to guide PCI in CTOs.
Literature
1.
Fefer P, Knudtson ML, Cheema AN, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012;59:991–7.CrossRefPubMed
2.
Kahn JK. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am Heart J. 1993;126:561–4.CrossRefPubMed
3.
Werner GS, Gitt AK, Zeymer U, et al. Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol. 2009;98:435–41.CrossRefPubMed
4.
Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol. 2005;95:1088–91.CrossRefPubMed
5.
Stone GW, Kandzari DE, Mehran R, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation. 2005;112:2364–72.CrossRefPubMed
6.
Zidar FJ, Kaplan BM, O’Neill WW, et al. Prospective, randomized trial of prolonged intracoronary urokinase infusion for chronic total occlusions in native coronary arteries. J Am Coll Cardiol. 1996;27:1406–12.CrossRefPubMed
7.
Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes Jr DR. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol. 2007;49:1611–8.CrossRefPubMed
8.
Cohen HA, Williams DO, Holmes Jr DR, et al. Impact of age on procedural and 1-year outcome in percutaneous transluminal coronary angioplasty: a report from the NHLBI Dynamic Registry. Am Heart J. 2003;146:513–9.CrossRefPubMed
9.
Anderson HV, Shaw RE, Brindis RG, et al. A contemporary overview of percutaneous coronary interventions. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). J Am Coll Cardiol. 2002;39:1096–103.CrossRefPubMed
10.
Williams DO, Holubkov R, Yeh W, et al. Percutaneous coronary intervention in the current era compared with 1985–1986: the National Heart, Lung, and Blood Institute Registries. Circulation. 2000;102:2945–51.CrossRefPubMed
11.
Serruys PW, van Geuns RJ. Arguments for recanalization of chronic total occlusions. JACC Cardiovasc Interv. 2008;1:54–5.CrossRefPubMed
12.
Stone GW, Colombo A, Teirstein PS, et al. Percutaneous recanalization of chronically occluded coronary arteries: procedural techniques, devices, and results. Catheter Cardiovasc Interv. 2005;66:217–36.CrossRefPubMed
13.
George S, Cockburn J, Clayton TC, et al. Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. J Am Coll Cardiol. 2014;64:235–43.CrossRefPubMed
14.
Olivari Z, Rubartelli P, Piscione F, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol. 2003;41:1672–8.CrossRefPubMed
15.
de Labriolle A, Bonello L, Roy P, et al. Comparison of safety, efficacy, and outcome of successful versus unsuccessful percutaneous coronary intervention in “true” chronic total occlusions. Am J Cardiol. 2008;102:1175–81.CrossRefPubMed
16.
Valenti R, Migliorini A, Signorini U, et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur Heart J. 2008;29:2336–42.CrossRefPubMed
17.
Grantham JA, Jones PG, Cannon L, Spertus JA. Quantifying the early health status benefits of successful chronic total occlusion recanalization: Results from the FlowCardia’s Approach to Chronic Total Occlusion Recanalization (FACTOR) Trial. Circ Cardiovasc Qual Outcomes. 2010;3:284–90.CrossRefPubMed
18.
Suero JA, Marso SP, Jones PG, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38:409–14.CrossRefPubMed
19.
Hoye A, van Domburg RT, Sonnenschein K, Serruys PW. Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992–2002. Eur Heart J. 2005;26:2630–6.CrossRefPubMed
20.
Jaguszewski M, Targonski R, Fijalkowski M, et al. Recanalization of isolated chronic total occlusions in patients with stable angina. Int J Cardiol. 2013;167:1542–6.CrossRefPubMed
21.
Appleton DL, Abbate A, Biondi-Zoccai GG. Late percutaneous coronary intervention for the totally occluded infarct-related artery: a meta-analysis of the effects on cardiac function and remodeling. Catheter Cardiovasc Interv. 2008;71:772–81.CrossRefPubMed
22.
Galassi AR, Tomasello SD, Reifart N, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention. 2011;7:472–9.CrossRefPubMed
23.
Morino Y, Kimura T, Hayashi Y, et al. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;3:143–51.CrossRefPubMed
24.
Nombela-Franco L, Urena M, Jerez-Valero M, et al. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Interv. 2013;6:635–43.CrossRefPubMed
25.
Patel VG, Brayton KM, Tamayo A, et al. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv. 2013;6:128–36.CrossRefPubMed
26.
Grantham JA, Marso SP, Spertus J, House J, Holmes Jr DR, Rutherford BD. Chronic total occlusion angioplasty in the United States. JACC Cardiovasc Interv. 2009;2:479–86.CrossRefPubMed
27.
Stone GW, Reifart NJ, Moussa I, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part II. Circulation. 2005;112:2530–7.CrossRefPubMed
28.•
Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213–21. Scorring system to predict true to true antegrade CTO guide wire crossing withing 30 minutes.CrossRefPubMed
29.••
Brilakis ES, Grantham JA, Rinfret S, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5:367–79. Proposed percutaneous treatment algorithm to esthablish maximal succes for CTO guide wire crossing.CrossRefPubMed
30.
Sun D, Wang J, Tian Y, et al. Multimodality imaging evaluation of functional and clinical benefits of percutaneous coronary intervention in patients with chronic total occlusion lesion. Theranostics. 2012;2:788–800.CrossRefPubMedCentralPubMed
31.
Werner GS, Surber R, Ferrari M, Fritzenwanger M, Figulla HR. The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction. Eur Heart J. 2006;27:2406–12.CrossRefPubMed
32.
Wright S, Lichtenstein M, Grigg L, Sivaratnam D. Myocardial perfusion imaging (MPI) is superior to the demonstration of distal collaterals in predicting cardiac events in chronic total occlusion (CTO). J Nucl Cardiol. 2013;20:563–8.CrossRefPubMed
33.
Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.CrossRefPubMed
34.
Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900–7.CrossRefPubMed
35.
Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002;39:1151–8.CrossRefPubMed
36.
Baks T, van Geuns RJ, Duncker DJ, et al. Prediction of left ventricular function after drug-eluting stent implantation for chronic total coronary occlusions. J Am Coll Cardiol. 2006;47:721–5.CrossRefPubMed
37.
Nii H, Wagatsuma K, Kabuki T, et al. Significance of percutaneous transluminal coronary intervention for chronic total occlusions assessed as non-viable by myocardial scintigraphy. J Cardiol. 2007;50:363–70.PubMed
38.
Di Carli MF, Maddahi J, Rokhsar S, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg. 1998;116:997–1004.CrossRefPubMed
39.
Di Carli MF. Predicting improved function after myocardial revascularization. Curr Opin Cardiol. 1998;13:415–24.CrossRefPubMed
40.
Bax JJ, Schinkel AF, Boersma E, et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation. 2004;110:II18–22.PubMed
41.
Bonow RO. Myocardial viability and prognosis in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2002;39:1159–62.CrossRefPubMed
42.
Beanlands RS, Nichol G, Huszti E, et al. F-18-fluorodeoxyglucose positron emission tomography imaging-assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: a randomized, controlled trial (PARR-2). J Am Coll Cardiol. 2007;50:2002–12.CrossRefPubMed
43.
Holly TA, Bonow RO, Arnold JM, et al. Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: results of the Surgical Treatment for Ischemic Heart Failure trial. J Thorac Cardiovasc Surg. 2014;148:2677–84.CrossRefPubMed
44.
Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.CrossRefPubMed
45.
Safley DM, Koshy S, Grantham JA, et al. Changes in myocardial ischemic burden following percutaneous coronary intervention of chronic total occlusions. Catheter Cardiovasc Interv. 2011;78:337–43.PubMed
46.
Khan MF, Wendel CS, Thai HM, Movahed MR. Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheter Cardiovasc Interv. 2013;82:95–107.CrossRefPubMed
47.•
Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol. 2013;20:874–90. Review on the value of CCTA, cardiac PET, and hybrid imaging.CrossRefPubMed
48.
Maddahi J, Czernin J, Lazewatsky J, et al. Phase I, first-in-human study of BMS747158, a novel 18F-labeled tracer for myocardial perfusion PET: dosimetry, biodistribution, safety, and imaging characteristics after a single injection at rest. J Nucl Med. 2011;52:1490–8.CrossRefPubMed
49.
Berman DS, Maddahi J, Tamarappoo BK, et al. Phase II safety and clinical comparison with single-photon emission computed tomography myocardial perfusion imaging for detection of coronary artery disease: flurpiridaz F 18 positron emission tomography. J Am Coll Cardiol. 2013;61:469–77.CrossRefPubMedCentralPubMed
50.
Nekolla SG, Reder S, Saraste A, et al. Evaluation of the novel myocardial perfusion positron-emission tomography tracer 18F-BMS-747158-02: comparison to 13N-ammonia and validation with microspheres in a pig model. Circulation. 2009;119:2333–42.CrossRefPubMed
51.
Bateman TM, Heller GV, McGhie AI, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol. 2006;13:24–33.CrossRefPubMed
52.•
Jaarsma C, Leiner T, Bekkers SC, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59:1719–28. Large meta-analysis on the diagnostic value of non invasive functional imgaing techniques.CrossRefPubMed
53.
Knuuti J, Kajander S, Maki M, Ukkonen H. Quantification of myocardial blood flow will reform the detection of CAD. J Nucl Cardiol. 2009;16:497–506.CrossRefPubMed
54.
Danad I, Raijmakers PG, Harms HJ, et al. Impact of anatomical and functional severity of coronary atherosclerotic plaques on the transmural perfusion gradient: a [15O]H2O PET study. Eur Heart J. 2014;35:2094–105.CrossRefPubMed
55.
Kaufmann PA, Camici PG. Myocardial blood flow measurement by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75–88.PubMed
56.
Knaapen P, de HS, Hoekstra OS, et al. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. Neth Heart J. 2010;18:90–8.CrossRefPubMedCentralPubMed
57.
Stuijfzand WJ, Uusitalo V, Kero T, et al. Relative flow reserve derived from quantitative perfusion imaging may not outperform stress myocardial blood flow for identification of hemodynamically significant coronary artery disease. Circ Cardiovasc Imaging. 2015; 8.
58.
Danad I, Uusitalo V, Kero T, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: cutoff values and diagnostic accuracy of quantitative [(15)O]H2O PET imaging. J Am Coll Cardiol. 2014;64:1464–75.CrossRefPubMed
59.
Choi JH, Chang SA, Choi JO, et al. Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries. Circulation. 2013;127:703–9.CrossRefPubMed
60.
Ripley DP, Gosling OE, Bhatia L, et al. The relationship between the contralateral collateral supply and myocardial viability on cardiovascular magnetic resonance: can the angiogram predict functional recovery? Int J Cardiol. 2014;177:362–7.CrossRefPubMed
61.
Chammas E, Hussein A, Ballane G, et al. Myocardial perfusion in patients with a totally occluded left anterior descending coronary artery reinjected by a normal right coronary artery: the role of collateral circulation. Angiology. 2008;59:464–8.CrossRefPubMed
62.
Tillisch J, Brunken R, Marshall R, et al. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med. 1986;314:884–8.CrossRefPubMed
63.
Bengel FM, Higuchi T, Javadi MS, Lautamaki R. Cardiac positron emission tomography. J Am Coll Cardiol. 2009;54:1–15.CrossRefPubMed
64.
Schwaiger M, Ziegler SI, Nekolla SG. PET/CT challenge for the non-invasive diagnosis of coronary artery disease. Eur J Radiol. 2010;73:494–503.CrossRefPubMed
65.
van Velzen JE, Schuijf JD, de Graaf FR, et al. Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis. Heart. 2009;95:1990–6.CrossRefPubMed
66.
Achenbach S, Marwan M, Ropers D, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010;31:340–6.CrossRefPubMed
67.
Springer I, Dewey M. Comparison of multislice computed tomography with intravascular ultrasound for detection and characterization of coronary artery plaques: a systematic review. Eur J Radiol. 2009;71:275–82.CrossRefPubMed
68.
Obaid DR, Calvert PA, Gopalan D, et al. Atherosclerotic plaque composition and classification identified by coronary computed tomography: assessment of computed tomography-generated plaque maps compared with virtual histology intravascular ultrasound and histology. Circ Cardiovasc Imaging. 2013;6:655–64.CrossRefPubMed
69.
Li M, Zhang J, Pan J, Lu Z. Obstructive coronary artery disease: reverse attenuation gradient sign at CT indicates distal retrograde flow—a useful sign for differentiating chronic total occlusion from subtotal occlusion. Radiology. 2013;266:766–72.CrossRefPubMed
70.
Choi JH, Kim EK, Kim SM, et al. Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. Circ Cardiovasc Imaging. 2014;7:482–90.CrossRefPubMed
71.
Hoe J. CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous coronary interventions. Int J Cardiovasc Imaging. 2009;25 Suppl 1:43–54.CrossRefPubMed
72.
Magro M, Schultz C, Simsek C, et al. Computed tomography as a tool for percutaneous coronary intervention of chronic total occlusions. EuroIntervention. 2010;6(Suppl G):G123–31.PubMed
73.
von Erffa J, Ropers D, Pflederer T, et al. Differentiation of total occlusion and high-grade stenosis in coronary CT angiography. Eur Radiol. 2008;18:2770–5.CrossRef
74.
Mollet NR, Hoye A, Lemos PA, et al. Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions. Am J Cardiol. 2005;95:240–3.CrossRefPubMed
75.
Cho JR, Kim YJ, Ahn CM, et al. Quantification of regional calcium burden in chronic total occlusion by 64-slice multi-detector computed tomography and procedural outcomes of percutaneous coronary intervention. Int J Cardiol. 2010;145:9–14.CrossRefPubMed
76.
Soon KH, Cox N, Wong A, et al. CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. J Interv Cardiol. 2007;20:359–66.CrossRefPubMed
77.
Ehara M, Terashima M, Kawai M, et al. Impact of multislice computed tomography to estimate difficulty in wire crossing in percutaneous coronary intervention for chronic total occlusion. J Invasive Cardiol. 2009;21:575–82.PubMed
78.
Garcia-Garcia HM, van Mieghem CA, Gonzalo N, et al. Computed tomography in total coronary occlusions (CTTO registry): radiation exposure and predictors of successful percutaneous intervention. EuroIntervention. 2009;4:607–16.CrossRefPubMed
79.
Rolf A, Werner GS, Schuhback A, et al. Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion. Int J Cardiovasc Imaging. 2013;29:1819–27.CrossRefPubMed
80.••
Opolski MP, Achenbach S, Schuhback A, et al. Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC Cardiovasc Interv. 2015;8:257–67. Proposed coronary computed tomography angiography prediction rule for percutaneous crossing of chronic total coronary occlusions.CrossRefPubMed
81.
Karmpaliotis D, Green P. Chronic total occlusion percutaneous coronary intervention in 2014 beyond the J-CTO score (Japanese Multicenter CTO Registry): chance favors the prepared mind. JACC Cardiovasc Interv. 2015;8:268–70.CrossRefPubMed
Metadata
Title
Value of Hybrid Imaging with PET/CT to Guide Percutaneous Revascularization of Chronic Total Coronary Occlusion
Authors
Wijnand J. Stuijfzand
Pieter G. Raijmakers
Roel S. Driessen
Niels van Royen
Alexander Nap
Albert C. van Rossum
Paul Knaapen
Publication date
01-07-2015
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 7/2015
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-015-9340-2