Opolski M P, Nap A, Knaapen P
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Neth Heart J. 2021 Jan;29(1):42-51. doi: 10.1007/s12471-020-01510-1. Epub 2020 Nov 11.
With wider adoption of coronary computed tomography angiography (coronary CTA), chronic total occlusions (CTOs) are being increasingly identified and characterised by non-invasive angiography. In particular, the ability of coronary CTA to clearly delineate atherosclerotic plaque, as well as to display three-dimensional vessel trajectories, has garnered particular attention in the context of preprocedural planning and periprocedural guidance of CTO percutaneous coronary intervention (PCI). Single CTO features and combined scoring systems derived from CTA (mostly exceeding the diagnostic performance of the angiographic J‑CTO score) have been used to predict time-efficient guidewire crossing, and thus grade the CTO difficulty level prior to PCI. In addition, the introduction of three-dimensional CTA/fluoroscopy co-registration for periprocedural navigation during CTO PCI offers the unprecedented opportunity to resolve proximal cap ambiguity and clearly visualise the distal CTO segment, thereby potentially influencing CTO PCI strategies and techniques. In this review, the potential advantages of non-invasive evaluation of CTO by coronary CTA are described, and a CTA-based hybrid algorithm is introduced for further enhancing the efficiency of CTO PCI. Further studies are clearly needed to verify the proposed approach. However, several luminary operators have already implemented coronary CTA for planning and periprocedural guidance of CTO interventions using the hybrid algorithm.
随着冠状动脉计算机断层扫描血管造影（冠状动脉CTA）的更广泛应用，慢性完全闭塞病变（CTO）越来越多地通过无创血管造影得以识别和特征描述。特别是，冠状动脉CTA清晰描绘动脉粥样硬化斑块以及显示三维血管走行的能力，在CTO经皮冠状动脉介入治疗（PCI）的术前规划和术中指导方面受到了特别关注。源自CTA的单一CTO特征和综合评分系统（大多超过血管造影J-CTO评分的诊断性能）已被用于预测高效导丝通过情况，从而在PCI术前对CTO难度水平进行分级。此外，在CTO PCI术中引入三维CTA/荧光透视共配准用于术中导航，为解决近端帽模糊问题并清晰可视化远端CTO节段提供了前所未有的机会，从而可能影响CTO PCI策略和技术。在本综述中，描述了冠状动脉CTA对CTO进行无创评估的潜在优势，并介绍了一种基于CTA的混合算法以进一步提高CTO PCI的效率。显然需要进一步的研究来验证所提出的方法。然而，一些杰出的术者已经在使用混合算法将冠状动脉CTA用于CTO介入治疗的规划和术中指导。
