J Korean Soc Radiol.  2012 Aug;67(2):93-99. 10.3348/jksr.2012.67.2.93.

Differentiation of Acute Total Occlusion of Coronary Artery from Chronic Total Occlusion in Coronary Computed Tomography Angiography

• Kwag HJ

• KMID: 2097956
• DOI: http://doi.org/10.3348/jksr.2012.67.2.93

Abstract

PURPOSE
To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO).
MATERIALS AND METHODS
CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST-elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated.
RESULTS
Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non-calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01).
CONCLUSION
CCTA shows various statistically significant differences between the ATO and CTO groups.

MeSH Terms

Acute Coronary Syndrome
Angina, Stable
Angiography
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Discrimination (Psychology)
Humans
Myocardial Infarction
Retrospective Studies
Tomography, X-Ray Computed

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