CCTA brings clarity, better outcomes to CTO PCI
Performing coronary CT angiography (CCTA) prior to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures is consistently associated with improved planning and better outcomes, according to new data published in The American Journal of Cardiology.[1]
“PCI of CTOs can be complex and requires detailed preparation,” wrote first author Sant Kumar, MD, a researcher with Creighton University School of Medicine in Phoenix, and colleagues. “CCTA is increasingly being used for planning CTO PCI, with promising results in a randomized controlled trial.”
To learn more about CCTA’s impact, Kumar et al. performed a systematic review of 56 studies that examined the use of CCTA-guidance during CTO PCI procedures. Overall, they found that CCTA provides significant value when patients present with complete blockages.
“From a procedural perspective, CCTA can help operators in three concrete ways,” the authors wrote. “First, it can improve case selection by identifying lesions that are more suitable for PCI versus those that may require referral to a dedicated CTO center or reconsideration of the revascularization strategy. Second, it can improve preprocedural planning by informing the likely crossing strategy, anticipated need for calcium modification, guidewire selection and requirement for advanced techniques such as antegrade dissection/re-entry or retrograde crossing. Third, it can improve risk stratification and procedural efficiency by identifying lesions likely to require longer procedure time, greater technical expertise and more resource-intensive support.”
Considering these benefits, CCTA utilization is still not as high in the United States as one may expect. This could be due to a lack of user experience, the authors wrote, and additional training—including collaborations with imaging specialists—could help more cardiologists feel comfortable with CCTA-guided procedures.
The group also highlighted the role artificial intelligence (AI) can play when it comes to evaluating CCTA images. If more AI models are developed with CTO PCI in mind, it could increase utilization across the board.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.