title: Computed tomography to predict surgical revascularization of a left anterior descending artery occlusion incompletely visualized by conventional angiography.
abstract: OBJECTIVE
  Previous studies demonstrated that failure to visualize distal chronic total occlusion in conventional coronary angiography (CCA) does not preclude procedural success of coronary artery bypass grafting (CABG). We assessed the utility of computed tomography angiography (CTA) in guiding CABG to the occluded left anterior descending artery (LAD) incompletely visualized by CCA.
  
  
  METHODS
  Twenty-four symptomatic patients rejected for revascularization of an occluded LAD on the basis of CCA underwent a preoperative CTA before intended transmyocardial laser revascularization. Off-pump CABG to the LAD was attempted in all patients depending on the intraoperative findings. The primary outcome was defined as procedural success of CABG to the LAD.
  
  
  RESULTS
  The success rate for CABG was 79.2%. By CCA, Rentrop 0/1 was present in 6 patients (25%), whereas Rentrop 2 was present in 18 patients (75%). By CTA, Rentrop 3 was seen in all patients. Compared with the CABG-failure group, the CABG-success group showed a larger mean distal LAD diameter (1.7 ± 0.2 mm vs. 1.3 ± 0.1 mm; P=0.001). By receiver-operating curve analysis, a cutoff value of 1.5 mm for the mean distal LAD diameter predicted CABG availability with 100% specificity and 95% sensitivity. The distal LAD short length and intramyocardial course were other significant correlates of CABG failure compared with CABG success (60% vs. 5.3%, P=0.018; 80% vs. 0%, P<0.001).
  
  
  CONCLUSIONS
  Noninvasive CTA is not only superior to CCA in delineating distal coronary occlusion but also very precisely predicts the procedural success of CABG. CTA represents a robust evaluation tool for coronary mapping of chronic total occlusion with doubtful distal anatomy in CCA.
authors.affiliation: Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Juraszynski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Pracon
authors.forename: Wojciech
authors.initials: W
authors.lastname: Dyk
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D017023:Coronary Angiography / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*