CT angiography boosts success in chronic total occlusion revascularization

March 16, 2018|Cardiology News

REPORTING FROM CRT 2018

WASHINGTON – When performed prior to revascularization, CT angiography almost doubles the likelihood of successful revascularization of chronic total occlusion relative to no CT angiography, according to a meta-analysis.

Because the meta-analysis relied primarily on retrospective data, the conclusion was characterized as hypothesis-generating. But the author, Wael Abuzeid, MD, an interventional cardiologist and assistant professor at Queen’s University, Kingston, Ont., suggested that there are several arguments to be made for pursuing a randomized trial.

When percutaneous intervention revascularization is conducted on the basis of coronary angiography alone, “there are important characteristics of CTO [chronic total occlusion] that are difficult to evaluate. These include proximal and distal vessel ambiguity, the extent to calcification, negative distal remodeling, and degree of tortuosity,” Dr. Abuzeid explained at CRT 18, sponsored by the Cardiovascular Research Institute at Washington Hospital Center. CT angiography (CTA) “provides a tremendous amount of information” on these and other characteristics that could help the operator anticipate problems and prepare strategies in advance of the procedure.

This is not a new idea, according to results of a systematic review of the literature. Although only four articles met prespecified criteria for entry into the meta-analysis that was eventually conducted, Dr. Abuzeid and his coauthors found 424 articles on this subject in a search of three literature databases.