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Can coronary computed tomography angiography be the complete roadmap for chronic total occlusion management?
  1. Clerio Francisco de Azevedo1,2,
  2. Márcio Sommer Bittencourt3,4
  1. 1 CDPI/ALTA Clinics, DASA, Rio de Janeiro, Brazil
  2. 2 Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
  3. 3 Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
  4. 4 Faculdade Israelita de Ciência da Saúde Albert Einstein, Hospital Israelita Albert Einstein and School of Medicine, São Paulo, Brazil
  1. Correspondence to Dr Clerio Francisco de Azevedo, Division of Cardiology, Duke University Medical Center, Duke Medical Pavilion, Durham, NC 27710, USA; clerio.azevedo{at}

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The incidence of chronic total occlusion (CTO) is reported to be as high as 25%, at least in individuals referred to invasive coronary angiography (ICA).1 In this scenario, CTO is also associated with a high mortality and Major Adverse Cardiac Events (MACE) incidence.1 Interestingly, this incidence of events is reported to be high even after the clinical profile and extent of coronary artery disease (CAD) in other vessels is accounted for.2 This relatively high prevalence and disproportionate rate of events has driven the attention of the interventional cardiologists in a quest to improve prognosis in the CTO setting. However, individuals referred for ICA represent a selected population of the individuals with suspected or known CAD, and the actual prevalence and event rates associated with CTO might be significantly lower if a less selected population is studied.

Coronary CT angiography (CTA) has been increasingly used in the investigation of suspected CAD. Over the last two decades, it has proven to provide adequate diagnostic and prognostic information for the presence, extent and severity of CAD.3 4 Recent evidence also suggests it can also have a meaningful impact on the management of CAD.5 6 More specifically, recent reports even suggest that coronary CTA might be useful for interventional procedural guidance in CTO.7 However, more comprehensive data on CTO detected …

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  • Contributors Both authors have provided substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafted the work or revising it critically for important intellectual content; given final approval of the version published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MSB has received research grants from Sanofi and speaker fees from Boston Scientific.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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