الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Chronic total occlusion (CTO) is defined as a TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 within the occluded segment with no antegrade filling of the distal vessel other than via collaterals that was confirmed or presumed to be >3 months old. CTO is common in patients with obstructive coronary artery disease. (Stone GW,et al 2005)
CT-RECTOR score is a new and accurate noninvasive tool for grading CTO suitability for successful and time efficient guidewire (GW) crossing.
The proposed CCTA score may be particularly applied to estimate the need for additional CTO devices or dedicated revascularization techniques in lesions with respectively higher difficulty levels. Furthermore, the excellent specificity of lesions with a low CT-RECTOR score ensures high GW success in the hands of experienced operators and could therefore be used for training purposes among less-skilled interventionalists. Also this CCTA-based scoring system does not suffer from the limitations of CCA and thus has the potential to exceed the discriminatory performance of the angiographic J-CTO score.
This study included 40 patients who undergone echo and CCTA before attempt PCI to a CTO & we had primary and secondary end point
The primary end point : is defined as successful GW crossing through the CTO within 30 min. of the procedure time ,which is the time from insertion of the GW into the vessel to the time it was successfully crossed through the lesion or was pulled out of the vessel because of unsuccessful GW crossing.
The secondary endpoint : is defined as 1)successful GW crossing through CTO at any time; 2)successful GW crossing through CTO with restoration of flow(< 50% residual stenosis and TIMI flow grade 2 to 3).
• Patients with FGW within 30 minutes showed increased proportions of proximal and osteal segment involvement, blunt stump, and second attempts, along with higher CT RECTOR and J CTO scores, signifying greater procedural complexity. Moreover, these patients had a lower percentage of TIMI flow II to III, more wires used, and a higher rate of treatment failure, all of which were statistically significant. In contrast, patients whose CTOs were SGW within 30 minutes exhibited more favorable outcomes in terms of successful procedures and reduced procedural challenges.
• The study found a statistically significant increase in the percentage of patients with a blunt stump and a second attempt in the FGW within 30-minute group compared to the SGW within 30 minute group. There was also a statistically significant increase in the median CT-RECTOR score and CT RECTOR classification that shows higher difficulty in the FGW within 30 minute group. However, no statistically significant relationship was found between the time efficient GW crossing and other parameters.
• There was a statistically significant increase in the percentage of patients with blunt stump , lesion length greater than 20 mm and a higher median J-CTO score in the FGW within 30 minutes group compared to the SGW within 30 minutes group also J CTO score classification that shows higher difficulty in patient with FGW within 30 minutes than SGW group . However, no statistically significant relationship was found between the time efficient GW crossing and other J-CTO score parameters.
• The ROC curve showed that the CT-RECTOR score can differentiate between patients with total time within 30 minutes and patients with total time after 30 minutes at the cut off point ≤ 1 with sensitivity of 75.0%, specificity of 91.67% and AUC of 0.875 while the J-CTO score can differentiate between the two studied groups at the cut off point ≤1 with sensitivity of 68.75%, specificity of 66.67% and AUC of 0.720.
• The study found a statistically significant increase in the percentage of patients with a bending angle greater than 45° and a second attempt in the failure group compared to the successful group. There was also a statistically significant increase in the median CT-RECTOR score in the failure group. However, no statistically significant relationship was found between the outcome and other parameters.
• There was a statistically significant increase in the percentage of patients with lesion length greater than 20 mm and a higher median J-CTO score in the failure group compared to the successful group. However, no statistically significant relationship was found between the outcome and other J-CTO score parameters.
• The ROC curve showed that the CT-RECTOR score can differentiate between successful and failure patients at the cut off point ≤ 2 with sensitivity of 75.76%, specificity of 85.71% and AUC of 0.842 while the J-CTO score can differentiate between successful and failure patients at the cut off point ≤1 with sensitivity of 54.55%, specificity of 85.71% and AUC of 0.740.
Conclusions
Our study found that the CT-RECTOR score is a useful tool for predicting the difficulty and time efficiency of guidewire (GW) crossing in chronic total occlusions (CTOs), as well as the ultimate success of the procedure. The CT-RECTOR score outperformed the J-CTO algorithm in predicting both short and long GW crossing times and final procedure success. These results suggest that the CT-RECTOR score may be a valuable tool for risk assessment and procedural planning for CTO interventions.
Limitations