Impact on adenosine stress cardiac magnetic resonance for recanalisation and follow up of chronic total coronary occlusions.
OBJECTIVE
To evaluate the impact on cardiac magnetic resonance imaging (CMRI) with adenosine stress and delayed enhancement for indication and follow up after interventional recanalisation of chronic total coronary occlusions (CTOs).


METHODS
Twenty consecutive patients (15 males; 5 females; mean age 65 years) with CTO verified by cardiac catheterisation referred to CMRI. Sixteen of them got CMRI before and after coronary recanalisation. Wall motion abnormalities (WMAs), first pass perfusion with adenosine and viability were assessed using a 1.5 T MR scanner (Sonata; Siemens). CMRI results were compared with clinical classifications, the results of cardiac catheterisation and follow up angiography.


RESULTS
Sixteen patients had a successful recanalisation, 15 of the occluded coronary artery and one of collateral donor artery stenosis. After recanalisation all stress-induced progressive or new wall motion abnormalities (WMAs) of the corresponding segments and in the collateral donor territory (5 patients) and all adenosine induced perfusion defects (PD) or delay (12 patients) were regredient. 13/16 patients showed no transmural and one patient transmural delayed enhancement (DE) indicating myocardial scar. In 10/16 patients CSS grading of angina improved after recanalisation.


CONCLUSIONS
After successful recanalisation of CTOs, patients with preinterventional stress-induced PDs and WMAs in viable myocardium did not display any signs of stress-induced ischemia postinterventionally. A comprehensive CMRI approach, including assessment of rest and stress WMAs, first pass perfusion and myocardial viability represents an important tool for the pre-interventional decision to recanalise CTOs and follow up.
Heyne
J P
JP
Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Jens-Peter.Heyne@med.uni-jena.de
Goernig
M
M
Feger
J
J
Kurrat
C
C
Werner
G S
GS
Figulla
H R
HR
Kaiser
W A
WA
D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization; D003287:Contrast Media; D023921:Coronary Stenosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015607:Stents; D014654:Vascular Patency; D014665:Vasodilator Agents
D003287:Contrast Media; D014665:Vasodilator Agents; D000241:Adenosine