Abstract
ObjectivesTo evaluate the association between duration of the coronary occlusion and high-intensity signal (HIS) on noncontrast T1-weighted imaging using a 1.5-T magnetic resonance imager among patients with angiographic coronary total occlusion.MethodsThe signal intensity of the coronary target area divided by the signal intensity of the left ventricular muscle near the target area at each site (TMR) was measured. Areas with a TMR >1.0 were defined as HIS. Thirty five lesions from 33 patients were divided into the following three groups: subacute occlusion (up to 3 months; n = 7), short-duration chronic total occlusion (SD-CTO: 3–6 months; n = 9) and long-duration CTO (LD-CTO: ≥6 months; n = 19).ResultsAll subacute occlusion lesions showed a HIS within the occlusion site. Among patients with CTO, the frequency of a HIS within the occlusion site was significantly higher in SD-CTO than in LD-CTO lesions (p = 0.013). In multivariate analyses, only an occlusion duration of less than 6 months was an independent factor associated with the presence of HIS (odds ratio 7.6, 95% CI 1.1–54.5; p = 0.044).ConclusionsThe presence of a HIS in the occlusion site was associated more with SD-CTO than with LD-CTO among patients with CTO.Key Points• All subacute occlusion lesions show a high-intensity signal on T1-weighted imaging.• HIS within occlusion sites is associated with subacute or short-duration total occlusion.• T1-weighted imaging for coronary total occlusion may be useful for intervention strategy.
Highlights
Patients with a chronic total occlusion (CTO) are often managed conservatively or surgically compared to those with percutaneous coronary intervention (PCI)
We suggest three levels of certainty for the occlusion duration, according to the previous reports [2, 12]: (a) ‘certain’, in lesions where a previous angiogram confirmed the presence of Thrombolysis in Myocardial Infarction (TIMI) 0 flow prior to the procedure; (b) ‘likely’, objective evidence of an acute myocardial infarction (AMI) in the territory of the occluded artery without other possible culprit arteries before the current angiogram; (c) ‘undetermined’, TIMI 0 flow and angiographic anatomy suggestive of long-standing occlusion with stable anginal symptoms unchanged or evidence of silent ischemia
On the basis of the ‘certain’ and ‘likely’ occlusion duration, 35 lesions from 33 patients with total occluded artery were further divided into subacute occlusion, short-duration CTO (SD-CTO: 3–6 months; n = 9) and long-duration CTO (LD-CTO: ≥6 months; n = 19), according to the estimated duration of total occlusion
Summary
Patients with a chronic total occlusion (CTO) are often managed conservatively or surgically compared to those with percutaneous coronary intervention (PCI). Several studies have shown that compared with conservative management, successful PCI for CTO provides significant benefits, represented. Coronary CTO is still the most challenging lesion for PCI, with a procedural success rate ranging from 60 to 70% compared with 98% for non-CTO PCI [1]. In cases of acute or subacute myocardial infarction, the occluding thrombus is disorganized, relatively soft, and crossed with a guide wire [3]. Olivari et al reported that, with regards to CTO duration, PCI failures increased only in patients with CTOs lasting more than 6 months [5]
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