A rationale for chronic total coronary occlusion revascularization: an evidence-based review of clinical trials

While the challenges associated with chronic total coronary occlusions may appear formidable, our evolving understanding of the benefits of revascularization has contributed to increasing interest in this lesion subset, reflected in an increasing number of chronic total occlusion (CTO) procedures, the development of novel technologies and the design of trials dedicated to CTO revascularization. Although studies examining the efficacy of stenting following CTO recanalization have consistently demonstrated improved outcomes than angioplasty alone, rates of restenosis and reocclusion remain unacceptably higher compared with those observed for treatment of non-occlusive lesions. Forthcoming trials evaluating the benefit of drug-eluting stents may enhance long-term vessel patency and complement observational findings that associate successful percutaneous revascularization with improved long-term survival. Considering the technical and clinical dilemmas that CTOs present, this overview summarizes the evidence regarding procedural and clinical outcomes associated with CTO revascularization and presents future directions for investigation.