Tahir Naveed, Bilal S Mohydin, Muhammad Ayub, Nadeem Hayat Mallick.
Evaluation of chronic total occlusion of coronary artery by 64 slice MDCT before a planned PCI.
J Cardiovascular Dis Jan ;12(4):90-6.

BACKGROUND AND OBJECTIVE:Sixty-Four slice Multi-Detector Computed Tomography (MDCT) evaluation of Chronic Total Occlusion (CTO) appears to be a new tool for planning the procedural strategy for PCI and thereby increasing its success rate. MDCT is done to define the lesion length, plaque morphology, calcium content and thus we can plan our strategy before going in for PCI to a CTO artery. MATERIAL AND METHODS:Thirty-five patients who had elective coronary angiography following ACS and CTO of the at least single coronary artery was identified &they were referred for 64 Slice MDCT for evaluation of CTO vessel. MDCT was done in patients having sinus rhythm and heart rate of 60-70 /min. Patients having Serum creatinine of >1.5 mg/dl and inability to hold breath were excluded RESULTS:Mean age was 53.84 ± 8.4 years. Mean BMI was 26.04 ±1.5.Thirty-one(88.57%) patients were males and four patients were females(11.4%). CTO vessel distribution was LAD 11(31.4%),LCx 12(34.28%) RCA 12(34.28%).Eleven (31.42%) patients had unstable angina FC II-III, sixteen (45.71%) patients had nonST elevation myocardial infarction (NSTEMI)and 08(23%) patients had ST-Elevation myocardial infarction (STEMI) Soft plaque morphology as adjudged on MDCT was present in twentytwo(62.85%) patients and, procedural success was achieved in nineteen (86.36%) of them. Thirteen (37.1%) patients had mixed plaque morphology on MDCT. Seven (53.8%) of them had successful PCI ,Six(46.6 %) patients had unsuccessful PCI. The lesion length ranges measured on MDCT of successful PCIs matched in 22(86%) of patients, three (11.53%) patients had lesion length more than the measured length on MDCT, one (3.8%)had stent size less than the measured length on MDCT. CONCLUSION: 64 slice MDCT evaluation of CTO vessel in ACS patients for determining plaque morphology and lesion length is possible and does help in guiding for the procedural success of PCI. High success rate of PCI was associated with soft plaque morphology as compared to mixed or calcified plaque morphology. KEY WORDS: Chronic Total Occlusion( CTO), Multi-Detector Computed Tomography (MDCT), Plaque Morphology, Procedural success

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