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Treatment of the chronic total occlusion: a call to action for the interventional community

Mauro Carlino1, Caroline J Magri, Barry F Uretsky

  • 1San Raffaele Scientific Institute, Milan, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 11, 2014
PubMed

Insights

Recanalization of chronic total occlusions (CTO) is beneficial but underutilized. This review examines the efficacy and safety of CTO percutaneous coronary intervention (PCI) to encourage appropriate clinical use.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine

Background:

  • Chronic total occlusions (CTOs) are common in coronary artery disease.
  • Percutaneous coronary intervention (PCI) for CTOs is technically challenging, leading to underutilization.
  • Misconceptions about CTO PCI efficacy persist, akin to the "Fox and the Grapes" fable.

Purpose of the Study:

  • To review current evidence on the efficacy and safety of CTO PCI.
  • To address the underutilization of CTO recanalization procedures.
  • To encourage appropriate use of CTO PCI based on data.

Main Methods:

  • Review of existing data on CTO percutaneous coronary intervention (PCI).
  • Analysis of efficacy and safety outcomes in the drug-eluting stent era.
  • Discussion of current challenges and future research needs.

Main Results:

  • Substantial evidence supports the benefits of CTO recanalization.
  • CTO PCI efficacy and safety are well-established in the current era.
  • Underutilization remains a significant issue despite evidence.

Conclusions:

  • CTO PCI is a valuable treatment option when indicated.
  • Further research is needed in specific areas of CTO intervention.
  • Interventional cardiologists should embrace CTO PCI based on current evidence.

Keywords:
chronic total occlusionscoronary artery bypass graftingcoronary artery diseasemyocardial infarctionpercutaneous coronary intervention

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