title: Factors determining success in percutaneous revascularization of chronic total coronary occlusion: multidetector computed tomography analysis.
abstract: OBJECTIVE
  Percutaneous revascularization of chronic total coronary artery occlusion is a technical challenge and has a lower success rate than other angioplasty procedures. Identification of predictors of failure could lead to better selection of patients with the greatest possibility of success. In this study, we investigate the multidetector computed tomography features associated with failure of percutaneous treatment for chronic total coronary occlusion.
  
  
  METHODS
  This is a prospective, single-center study of 69 consecutive patients with chronic total occlusion in whom multidetector computed tomography study was performed before percutaneous coronary revascularization.
  
  
  RESULTS
  Seventy-seven lesions were analyzed. The mean length of the occlusion was 19.9 (14.3) mm and the estimated duration of occlusion was 47 (62) months. The only angiographic factor independently predictive of failure was a severe curve between the plaque and the proximal patent vessel (odds ratio 3.8, 95% confidence interval, 1.2-12; P=.02). On multidetector computed tomography, the only factor predictive of failure was an arc of calcium affecting more than 50% of the vessel circumference in the proximal (P=.04) and middle (P=.03) third of the occlusion.
  
  
  CONCLUSIONS
  Multidetector computed tomography identified a variable that cannot be measured by angiography that can predict failure in percutaneous revascularization of chronic total coronary occlusions. In selected cases, this parameter could be useful for preprocedure screening.
authors.affiliation: Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain. 27700vmy@comb.cat
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín-Yuste
authors.forename: Antonio
authors.initials: A
authors.lastname: Barros
authors.forename: Ruben
authors.initials: R
authors.lastname: Leta
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Sandra
authors.initials: S
authors.lastname: Pujadas
authors.forename: Francesc
authors.initials: F
authors.lastname: Carreras
authors.forename: Guillem
authors.initials: G
authors.lastname: Pons
authors.forename: Joan
authors.initials: J
authors.lastname: Cinca
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
mesh_terms: D000368:Aged; D002118:Calcium / Q000378:metabolism; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013030:Spain; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002118:Calcium