Role of Preprocedural Multi Detector Computed Tomography Angiography in Prediction of Complexity & Outcome of Coronary Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract Background Chronic Coronary Total Occlusion (CTO) is considered one of the most challenging obstructive coronary artery diseases that had been widely managed medically or referred for bypass surgeries due to their complex nature which remained an obstacle for the operators. Coronary CT- angiography was used to develop easy predictive tools for CTO percutaneous intervention. Objectives To evaluate the ability of the CCTA and CT-RECTOR score to predict time-efficient guidewire (GW) crossing through a chronic total occlusion. Patients and Methods The present study included 40 patients with CTO lesions. All were subjected to preoperative CTO assessment using CCTA and CCA before an attempt of PCI to a CTO in the period between January 2022 and May 2023. The study was held in Ain Shams University hospitals and National Heart Institute. Results We divided the patients into two groups according to GW crossing within 30 minutes. Group 1 included patients with successful GW crossing within 30 min, group 2 included patients with failed GW crossing within 30 min. We compared the two groups according to demographic data and we found that males are more common to have CTO lesions (87.5%) which were predominantly located in RCA (50% of total no. with 76.9% of them in failed group, p = 0.018). Our results showed that CTOs with occlusion length ≥ 20 mm or calcification increased in failed group, but was not statistically significant (84.6% in failed group (p = 0.161) and 46.3% in failed group (p = 0.432) respectively). In addition, there was a statistical significance between presence of blunt stump (76.9% in failed group vs 29.6% in successful group, p = 0.004), a previous failed CTO-PCI attempt (53.8% in failed group vs 14.8% in successful group p = 0.009), and using retrograde wiring techniques (p = 0.003) between the successful and failed groups. Indicating that these points were important predictors of procedural failure. We compared CTO characteristics between CCTA-derived CT-RECTOR score and CA-derived J-CTO score. with increased score points, the probability of PCI difficulty and GW crossing failure increased. CT-RECTOR score was found to have the better ability for prediction of GW crossing within 30 min and CTO-PCI difficulty (p = 0.028). Conclusion CT-RECTOR score was superior to J-CTO score in the assessment and prediction of GW crossing difficulty within 30 minutes and final procedural outcomes.