Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine

Background:

• Coronary chronic total occlusion (CTO) presents significant challenges in interventional cardiology.
• Despite advancements, CTO interventions carry inherent risks of complications impacting patient outcomes.

Purpose of the Study:

• To comprehensively review and classify the spectrum of potential complications associated with percutaneous coronary intervention (PCI) for CTO.
• To emphasize the critical need for understanding these risks to improve procedural safety and mitigate adverse events.

Main Methods:

• Systematic review and classification of reported complications from percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs).
• Categorization of complications into coronary, cardiac non-coronary, and extra-cardiac events.
• Identification of complications unique to CTO procedures and specialized techniques.

Main Results:

• Complications range from coronary issues (occlusion, perforation, embolization) to cardiac (myocardial infarction) and extra-cardiac events (access site issues, nephropathy, radiation injury).
• Specific complications like donor vessel dissection/thrombosis and those from dissection/reentry or retrograde techniques are highlighted.
• A wide array of potential adverse events necessitates careful consideration during CTO interventions.

Conclusions:

• Thorough knowledge of potential complications is essential for interventional cardiologists performing CTO PCI.
• Mitigating risks associated with CTO interventions requires a deep understanding of the procedural complexities and potential adverse events.
• Improved operator expertise and medical devices do not eliminate the inherent risks, underscoring the importance of risk management strategies.