title: Impact of multislice computed tomography to estimate difficulty in wire crossing in percutaneous coronary intervention for chronic total occlusion.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains a challenge. Multislice computed tomographic coronary angiography (CTCA) allows noninvasive evaluation of the coronary artery by visualizing vessel trajectory and morphological features at the occluded site. The aim of this study was to assess the value of CTCA to predict the success of guidewire crossing in PCI to treat CTOs.
  
  
  METHODS
  We performed CTCA in patients with CTOs (of > 3 months' duration); 110 lesions were scanned. Wiring success was defined as complete crossing of the guidewire past the occluded site. Correlation of the following morphological parameters with wiring success was analyzed: target vessel bending (defined as > 45 degrees), shrinkage, severe calcification, presence of side branches, stump morphology, in-stent occlusion and occlusion length.
  
  
  RESULTS
  Wiring success was obtained in 93 lesions (85%). In the unsuccessful group, bending, shrinkage and severe calcification were significantly higher compared to the successful group (76% vs. 18%, p < 0.0001; 29% vs. 4%, p = 0.0005; 41% vs. 18%, p = 0.0356, respectively). The wiring success rate was significantly lower in cases with bending, shrinkage and severe calcification (57% vs. 95%, p < 0.0001; 44% vs. 88%, p = 0.0005; 71% vs. 88%, p = 0.0356, respectively). Stump morphology, in-stent occlusion or occlusion length did not significantly affect the outcome. Multivariate analysis showed that bending, shrinkage and severe calcification remained significant independent predictors of wiring failure.
  
  
  CONCLUSIONS
  Bending, shrinkage and severe calcification are significant predictors for wiring success. CTCA provides a practical determinant of the outcomes in PCI to treat CTOs.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi-City, Aichi, Japan. momomar@muc.biglobe.ne.jp
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Masato
authors.initials: M
authors.lastname: Kawai
authors.forename: Sunichi
authors.initials: S
authors.lastname: Matsushita
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Tuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome