title: CT features in the early and late stages of chronic total coronary occlusions.
abstract: OBJECTIVE
  To investigate the morphologic characteristics of early and late stages of chronic total coronary artery occlusions (CTO) in coronary computed tomography angiography (coronary CTA).
  
  
  METHODS
  We retrospectively analyzed patients who underwent coronary CTA and invasive coronary angiography and had at least one CTO with known duration. The following parameters were obtained in coronary CTA: calcification of the occluded segment; stump morphology; lesion length; remodeling index; presence of intra-occlusion linear contrast enhancement; and density of non-calcified CTO components. CT parameters were compared between patients with early (duration ≤ 12 months) and late (duration > 12 months) stage CTO.
  
  
  RESULTS
  One-hundred and twelve patients with 124 chronically occluded coronary arteries were analyzed. Fifty nine patients had early stage CTOs (62 lesions) and 53 patients had late stage CTOs (62 lesions). Calcification was more severe in late-stage versus early CTOs (Agatston score: early stage, 27.4 ± 46.7 vs. late stage, 58.3 ± 112.4; p = 0.049). Remodeling index was lower in late-stage CTOs (early stage, 0.96 ± 0.2 vs. late stage, 0.88 ± 0.22; p = 0.034). In patients with late stage CTO, the presence of intra-occlusion linear enhancement was more likely (45.2% vs 14.5%, p < 0.001), and the density of non-calcified components was significantly higher (85.4 ± 27.2 HU vs. 65.7 ± 30.1 HU, p < 0.001). Stump morphology was not different between the two groups.
  
  
  CONCLUSIONS
  Coronary CTA reveals differences between chronic total coronary occlusions of longer and shorter duration. A long duration is associated with focal calcification and negative remodeling, as well as intra-occlusion enhancement and a higher density of non-calcified components.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tong Ji University, School of Medicine, 1800 Yuntai Rd, Shanghai, 200120, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Xu
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China. Electronic address: andrewssmu@msn.com.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China. Electronic address: drliyuehua@126.com.
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Li
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
authors.forename: Minghua
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Wei
authors.affiliation: Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, 100037, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging; D066253:Vascular Remodeling
keywords: Calcification; Chronic total occlusion; Computed tomography; Coronary artery disease; Remodeling