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A chronic total occlusion (CTO) is present in 15-20% of patients who are referred for invasive coronary angiography. CTO Percutaneous Coronary Intervention (PCI) procedure success rates have increased over the years and can be as high as 90% when performed by high-volume CTO operators.Procedurally, excess calcification in the CTO anatomy is one factor which makes it difficult to complete the procedure or obtain ideal stent expansion. Excess calcification is best identified by Computed Tomography Coronary Angiography (CTCA) rather than invasive angiography.
The investigators plan to retrospectively evaluate CTCA in patients who underwent CTO PCI and correlate calcification characteristics with CTO PCI outcomes and tools utilised for calcium modification.
Cohort: All coronary CTO patients who underwent a PCI attempt and also underwent CTCA at our centre in the last 5 years.
Method of identifying and consenting patients: Screening of our local database to identify suitable patients who fulfil the inclusion/exclusion criteria. These patients will be telephoned and the consent form and participant information sheet will be maile dot them along with a self addressed stamped envelope.On receipt of the consent form, we will countersign it and return a copy to the patient. Consented patients' images and reports of the CTCA and CTO PCI will be reviewed.
Characteristics of calcification in the CTO on the CTCA will be evaluated including site, density and quantity of calcification. This will be correlated with CTO PCI outcomes of success and failure. Also this will be correlated with use of calcium modification tools for the CTO PCI.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CTO patients who underwent attempted PCI | Patients with coronary CTO who underwent attempt at PCI and also underwent a CTCA |
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| Measure | Description | Time Frame |
|---|---|---|
| Correlation of characteristics of calcification with CTO PCI outcome (success or failure) | Success or failure | up to 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Utility of calcium modifying tools for the CTO PCI procedure and correlation with severity of calcification | Percentage of patients in whom any calcium modifying tool was used and the corelation of this with the severity of calcification. | up to 24 hours |
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Inclusion Criteria:
Patients meeting all the below criteria will be included
Exclusion Criteria:
Patients meeting any of the following criteria will be excluded
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Patients with coronary CTO who underwent attempt at PCI and also underwent CTCA
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Vinoda Sharma, FRCP | Contact | +44(0)1215075841 | vinodasharma@nhs.net | |
| Kelly Hard | Contact | +44(0)121 507 4811 | swbh.randd.generic@nhs.net |
| Name | Affiliation | Role |
|---|---|---|
| Vinoda Sharma, FRCP | Sandwell & West Birmingham Hospitals NHS Trust | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Birmingham City Hospital, Sandwell and West Birmingham NHS Trust | Recruiting | Birmingham | West Midlands | B18 7QH | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29330258 | Background | Tajti P, Brilakis ES. Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies. J Am Heart Assoc. 2018 Jan 12;7(2):e006732. doi: 10.1161/JAHA.117.006732. No abstract available. | |
| 23352817 | Background | Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher D, Abdullah S, Banerjee S, Brilakis ES. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv. 2013 Feb;6(2):128-36. doi: 10.1016/j.jcin.2012.10.011. Epub 2013 Jan 23. |
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| ID | Term |
|---|---|
| D002114 | Calcinosis |
| ID | Term |
|---|---|
| D002128 | Calcium Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| Background | Simon W. The Consistent CTO Study. 2018. |
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