title: Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions.
abstract: Coronary computed tomography angiography (CTA) may be helpful to manage patients with chronic coronary occlusions. The aim of this study was to determine the sensitivity and specificity of CTA to detect the presence and extent of coronary collaterals as compared to invasive coronary angiography (ICA). We retrospectively evaluated 26 patients who underwent both coronary CTA and ICA within 3 weeks and demonstrated a total coronary occlusion (TIMI grade 0) in one of the major coronary arteries. CTA was performed using a 64-slice multidetector CT. The presence, and extent of collateralization was assessed by two blinded observers using the Rentrop classification for ICA. CTA accurately identified the presence and location of all 26 total occlusions. The presence of any collaterals was accurately detected in 21/23 patients [sensitivity 91% (CI: 71-98%)] and the absence in three patients [specificity 100% (CI: 29%-100%)]. The sensitivity of coronary CTA to identify patients with collateralization increased from 91 to 94% (CI: 71-99%) and 100% (CI: 59-100%) for collaterals Rentrop grade 2 and 3 in ICA, respectively. Coronary CTA accurately detects the presence of any coronary collateralization in patients with total occlusions. Although CT technology is currently limited in the assessment of individual collaterals and smaller vessels, it may be helpful in the management of patients with total occlusions.
authors.affiliation: Department of Cardiology, Division of Internal Medicine, University of Munich, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieber
authors.forename: Tej N
authors.initials: TN
authors.lastname: Sheth
authors.forename: Eline A Q
authors.initials: EA
authors.lastname: Mooyaart
authors.forename: Michael D
authors.initials: MD
authors.lastname: Shapiro
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D003097:Collateral Circulation; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*