Author + information
- Joseph Abunassar,
- Mohammed Alturki and
- Wael Abuzeid
Percutaneous revascularization of coronary chronic total occlusions (CTO) is technically more difficult but can benefit a select patient population. The angiographic JCTO score is validated to predict anterograde CTO recanalization success. This score consists of four components, namely the presence of a blunted proximal cap, occlusion length, presence of calcification and angulation of more than 45 degrees. We sought to determine if pre-PCI CTA could add incremental predictive value to this score.
We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from January 1, 1947, to December 31, 2016. Studies reporting on the use of computed tomography (CT) to aid in CTO revascularization were included. Case reports and case series were excluded.
We identified 424 articles, and using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method, 32 articles met prespecified inclusion criteria. Due to heterogeneity of the CTO patient population, it was deemed inappropriate to perform a meta-analysis for summary measures/effect size. Thirteen of 32 studies reported the presence of a blunted stump as a predictor of failure. Twenty-one of 32 studies reported occlusion length as a predictor of failure. Twenty eight of 32 studies reported severity of calcification as predictor of successful CTO recanalization. The degree of calcification was found to be better assessed with CTA than with coronary angiography. Eight of 32 studies reported steep angulations as a predictor of successful CTO recanalization. In addition, 3 of 32 studies identified CT derived linear intrathrombus enhancement, negative remodelling and the presence of multiple occlusions as novel predictors of success, uniquely identified by CTA.
This systematic review shows the validity of JCTO variables as determined by pre-procedural CTA. In addition to these variables, CT can also uniquely identify additional variables that can predict successful CTO recanalization.