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Updated: Jul 17, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
[Chronic total coronary occlusions: an overview]
Rosario Fiorilli1, Francesco De Felice, Roberto Violini
1U.O. di Cardiologia Interventistica, A.O. San Camillo-Forlanini, Roma. rosario.fiorilli@tiscali.it
Insights
Chronic total coronary occlusion (CTO) treatment via percutaneous coronary intervention is challenging but offers improved survival and cardiac function. Stenting, especially with drug-eluting stents, reduces restenosis rates for CTOs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Context:
- Chronic total coronary occlusion (CTO) affects approximately one-third of diagnostic catheterizations.
- Many CTOs are untreated or managed with coronary bypass surgery due to intervention challenges.
- Percutaneous coronary interventions (PCI) for CTOs face low success rates, high costs, and restenosis concerns.
Purpose:
- To review the challenges and benefits of percutaneous recanalization for chronic total coronary occlusions.
- To identify criteria justifying interventional approaches for CTOs.
- To discuss the role of stent implantation and drug-eluting stents in improving CTO treatment outcomes.
Summary:
- CTO is a >3-month obstruction of a coronary artery, histologically characterized by fibro-atheromatous plaque and thrombus.
- Interventional treatment is indicated for CTOs with demonstrated ischemia or myocardial viability and favorable angiographic features.
- Procedural failure in CTO PCI is often due to the inability to cross the lesion with a guidewire.
Impact:
- Successful CTO revascularization improves long-term survival, reduces symptoms, enhances left ventricular function, and decreases the need for coronary bypass surgery.
- Stent implantation significantly lowers restenosis rates compared to balloon angioplasty alone.
- Drug-eluting stents show potential for further improving long-term results in CTO treatment.
Abstract:
Chronic total coronary occlusion is defined as a > 3-month-old obstruction of a coronary artery with no anterograde filling of the distal vessel. Histologically it consists of various degrees of fibro-atheromatous plaque and thrombus depending on the mechanism of occlusion and its duration. It is identified in approximately one third of diagnostic catheterizations, but it accounts for only 10% of all percutaneous coronary interventions, as many coronary occlusions are left untreated or referred for coronary bypass surgery. Percutaneous recanalization of a coronary occlusion presents great challenges including immediate low success rates, high costs and high restenosis rates. An interventional approach is justified when ischemia or residual myocardial viability are demonstrated in the area supplied by an occluded vessel with favorable angiographic characteristics for stenting. A successful revascularization is associated with an improved long-term survival, less symptoms, a better left ventricular function and reduced need for coronary bypass surgery. The inability to cross the lesion with an angioplasty wire is the main reason for procedural failure. Stent implantation reduces the restenosis rate as compared to only balloon angioplasty, and drug-eluting stents probably further improve long-term results.
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