Differentiation of Acute Total Occlusion of Coronary Artery from Chronic Total Occlusion in Coronary Computed Tomography Angiography

The differentiation between acute total occlusion (ATO) of coronary artery and chronic total occlusion (CTO) is important because the therapeutic strategy of these two entities differ (1, 2). Acutely occluded coronary artery in patients with acute coronary syndrome (ACS) must be treated immediately, using reperfusion therapy, whereas, many patients with CTO are managed conservatively (3-5). Although the diagnosis of coronary artery disease is made comprehensively, using cardiac biomarkers, patient symptoms, electrocardiography (ECG), and imaging findings, it is not always possible to determine whether the patient has a culprit lesion or not (6-9). Furthermore, when complete interruption of enhanced coronary arterial lumen is encountered, in coronary computed tomography angiography (CCTA), it is difficult to decide whether it is a culprit lesion because the presenting symptom and the laboratory results may sometimes not be helpful in properly triaging the patient. With advances in multi-detector computed tomography (MDCT) technology, many studies have demonstrated that Original Article