[Chronic total occlusions]

Many studies showed that successful recanalization of chronic total occlusion (CTO) provides an improvement of long-term outcome and left ventricular ejection fraction, electrical stability of the myocardium, increased tolerance to future coronary events, and last but not least an improvement in quality of life. Because of the perceived procedural complexity of percutaneous coronary interventions (PCI), patients with CTO are usually referred to coronary artery bypass surgery or medical therapy. Recent advances in PCI materials, devices, approaches, and techniques have allowed expert operators to tackle successfully with complex cases of CTO that many years ago would have sent patients to surgery. This has also been motivated by the long-term patency and freedom from restenosis obtained by drug-eluting stent implantation. Each strategy and device has advantages and disadvantages, even though percutaneous treatment of CTO needs a higher operator's skill with respect to other non-occlusive lesions as well as an appropriate training period. In order to avoid complications and to achieve CTO recanalization in more than 70% of cases, it is advisable to understand the principles of each strategy, to plan the proper strategy and choose the appropriate materials, to take time, to be zen and aware when to stop.