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Role of Coronary Computed Tomography Angiography in Percutaneous Coronary Intervention of Chronic Total Occlusions

  • Intravascular Imaging (AG Truesdell, Section Editor)
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A Correction to this article was published on 27 June 2020

This article has been updated


Purpose of Review

Despite significant advances in procedural techniques for revascularization of chronic total occlusions (CTO), comprehensive procedural planning and accurate prediction of procedural success remain the Achilles’ heels of CTO percutaneous coronary intervention (PCI). Understanding the unique anatomic characteristics of CTOs that may predict relative success and complication rates of revascularization is imperative. Coronary computed tomography angiography (CCTA) has evolved as an adjunct to invasive angiography to better characterize CTO lesions to improve success rates of CTO PCI.

Recent Findings

Invasive angiography may be inadequate to characterize CTOs due to its inability to fully visualize the occluded segment. CCTA has evolved as a valuable adjunct to angiography, as it permits imaging of the arterial wall in the absence of luminal contrast, and thereby provides additional information regarding both the vessel course and lesion characteristics. CCTA-derived data can also be used in either standalone or combined scoring systems to assess the difficulty level of CTO PCI and has been shown to predict procedural success in clinical trials. Real-time CT fusion with X-ray angiography provides intraprocedural guidance to help resolve proximal cap ambiguity and better determine vessel course.


In this review, we discuss the role of CCTA in guiding and improving outcomes of CTO PCI, both pre-procedurally and in real time.

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Change history

  • 27 June 2020

    The original version of this image was of lower quality. The corrected image provides a better definition of the structures.



Chronic total occlusion


Multicenter Chronic Total Occlusion Registry of Japan




Clinical and lesion-related


Ostial location, Rentrop grade < 2, age ≥ 75 years


Prospective Global Registry for the Study of Chronic Total Occlusion Intervention


Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom


Computed Tomography Registry of Chronic Total Occlusion Revascularization


Saphenous vein graft


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations


Corresponding author

Correspondence to Poonam Velagapudi.

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Conflict of Interest

Poonam Velagapudi: None.

J Dawn Abbott: Research grants: Abbott Vascular, Sinomed, Biosensors Research USA.

Mamas Mamas: None.

Ron Blankstein: Research support from Amgen Inc. and Astellas Inc.

Yiannis Chatzisisis: Speaker honoraria, consultation fees, research grant by Boston Scientific, and research support by Medtronic.

Emmanouil S. Brilakis: Consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures.

Farouc Jaffer: Sponsored research from Canon, Siemens, and Shockwave; consultant for Boston Scientific, Abbott Vascular, Siemens, Philips, Biotronik, and Acrostak; equity interest, Intravascular Imaging, Incorporated. Massachusetts General Hospital has a patent licensing arrangement with Canon; FAJ has the right to receive royalties.

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Velagapudi, P., Abbott, J.D., Mamas, M. et al. Role of Coronary Computed Tomography Angiography in Percutaneous Coronary Intervention of Chronic Total Occlusions. Curr Cardiovasc Imaging Rep 13, 20 (2020).

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