Coronary Artery Total Occlusion: MR Angiographic Imaging Findings and Success Rates of Percutaneous Coronary Intervention according to Intraluminal Signal Intensity Patterns.

Abstract

To compare the success rates of percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO) lesions according to the different signal intensity (SI) patterns seen at coronary magnetic resonance (MR) angiography. Institutional review board approval was obtained, and all patients gave written informed consent. This study included 95 CTO lesions in 93 consecutive patients who underwent steady-state free-precession coronary MR angiography with a 1.5-T imager before PCI. The SI and length of CTO lesions were evaluated at coronary MR angiography, and the lesions were classified into two groups according to the continuity of the areas of high SI in the CTO lesions. Invasive angiographic findings including lesion length and collateral grades were analyzed. A multivariable logistic regression analysis was performed to identify variables associated with successful PCI. Seventy-eight (82%) of 95 CTO lesions were treated successfully with PCI. On coronary MR angiograms, areas of continuous high SI were found in 42 lesions (44%), and 40 (95%) of them were treated successfully with PCI. Thirty-eight (72%) of 53 lesions with low SI or interrupted high SI throughout the CTO segments were successfully treated with PCI. The presence of areas of continuous high SI in the CTO segments was the only independent predictor of PCI success (odds ratio, 8.20; 95% confidence interval: 1.08, 62.15; P = .042). Continuous areas of high SI in CTO lesions on coronary MR angiograms are predictive of better success rates with PCI than are discontinuous or absent areas of high SI.