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The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention: a systematic review and meta-analysis

  • Cardiac
  • Published:
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Abstract

Objectives

To systematically investigate and summarize the utility of coronary computed tomographic angiography (CCTA) in the management of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI).

Methods

The authors searched the four databases between 2005 and 2023 for studies investigating the role of CCTA and invasive coronary angiograms (ICA) images when used as the pre-procedural tool for CTO-PCI. Efficacy and safety of CCTA in CTO-PCI treatment as a pre-procedural assessment tool was evaluated.

Results

Forty-seven studies were finally chosen for this systematic review. CCTA had a high degree of agreement with ICA when applied for J-CTO scoring system. A J-CTO (Multicenter CTO Registry in Japan) score > 3, together with calcification, occlusion length ≥ 20 mm, blunt stump, and bending > 45° were shared imaging risk factors on both ICA and CCTA for technique failure and guidewire crossing over 30 min. Additionally, negative remodeling and multiple diseased vessel were significant indicators on CCTA. Although patients with pre-procedural CCTA showed a trend of higher success rate and easier guidewire crossing, and CCTA showed a slightly higher predictive accuracy for process success, no significant improvement in post-PCI major adverse cardiac events of using CCTA for assessment has been achieved.

Conclusions

CCTA is a safe and effective pre-operative tool of CTO-PCI. Except for the shared imaging risk factors with ICA for a hard CTO-PCI including calcification, occlusion length ≥ 20 mm, blunt stump, bending > 45°, and J-CTO score > 3, factors like negative remodeling and multiple diseased vessel were also recognized as significant pre-operative assessment indicators on CCTA.

Clinical relevance statement

A pre-procedural assessment based on coronary computed tomographic angiography has the potential to aid in the management of chronic total occlusion percutaneous coronary intervention.

Key Points

• A coronary computed tomographic angiography–based pre-procedural assessment can help chronic total occlusion-percutaneous coronary intervention management.

• The recognized high-risk features detected via coronary computed tomographic angiography and invasive coronary angiograms are comparable in detecting difficult lesions and chronic total occlusion-percutaneous coronary intervention failure.

• Coronary computed tomographic angiography has an additional value to be a safe and effective pre-procedural assessment tool for chronic total occlusion-percutaneous coronary intervention.

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Abbreviations

AUC:

Area under the curve

CCTA:

Coronary computed tomographic angiography

CI:

Confidence interval

CTO:

Chronic total occlusion

ESUR:

European Society of Urogenital Radiology

ICA:

Interventional coronary angiograms

J-CTO:

Multicenter CTO Registry in Japan

LAD:

Left anterior descending artery

LCX:

Left circumflex artery

MACEs:

Major adverse cardiac events

NOS:

Newcaslte-Ottawa Scale

OR:

Odds ratio

PCI:

Percutaneous coronary intervention

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCA:

Right coronary artery

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Funding

This work was supported by National Natural Science Foundation of China (No. 82200553), Key Research and Development Programs of Sichuan Province (No. 2023YFG0276), and the Key Research and Development Programs of Sichuan Province (No. 2022YFS0357).

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Author notes

  1. Shichu Liang and Yanlin Bai contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China

    Shichu Liang, Jing Zhang & Yong He

  2. West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Yanlin Bai

  3. West China School of Nursing, Sichuan University, Chengdu, China

    Jing Zhang

  4. Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China

    Aijie Wang & Kaiyue Diao

  5. Research Center of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Jing Li

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Liang, S., Bai, Y., Zhang, J. et al. The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention: a systematic review and meta-analysis. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10341-8

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