Computed tomography perfusion and angiography in patients with chronic total occlusion undergoing percutaneous coronary intervention

Background and aims Myocardial perfusion imaging (MPI) and anatomical imaging with coronary computed tomography angiography (CCTA) can play an important role in the preprocedural planning of a chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aimed to establish the feasibility of a novel dynamic computed tomography perfusion (CTP) analysis for the assessment of myocardial perfusion before and after a successful recanalization of CTO in patients undergoing CCTA as part of a standard preprocedural workup. Methods In a prospective observational study symptomatic patients underwent dynamic CTP on a dual-source CT scanner both before and 3 months after successful CTO PCI. Results Twenty-seven patients completed the study (63 ± 8 years old, 78% male). Following successful CTO PCI, there was a significant reduction in the ischemic burden (5 [5–7] versus 1 [0–2] segments, p < 0.001), and improvement in myocardial blood flow (85.3 [71.7–94.1] versus 134.6 [123.8–156.9] mL/min, p < 0.001) resulting in an increase in the relative flow reserve (0.49 [0.41–0.57] versus 0.88 [0.74–0.95], p < 0.001). Conclusions CTP emerges as a robust and safe method for MPI in CTO patients. The single imaging session assessment of both coronary anatomy and perfusion with CT lends itself to precise disease phenotyping in the challenging population of CTO patients.