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Percutaneous revascularization of chronic total occlusions: Rationale, indications, techniques, and the cardiac

Lorenzo Azzalini1, Gianluca Torregrossa2, John D Puskas2

  • 1Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

International Journal of Cardiology
|January 17, 2017
PubMed

Insights

Chronic total occlusion (CTO) revascularization is undertreated but offers improved outcomes. Modern techniques achieve high success rates for CTO treatment, enhancing patient survival and quality of life.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Chronic total occlusions (CTOs) are common and often lead to incomplete revascularization, associated with poorer long-term outcomes, including mortality.
  • Despite clinical indications, CTO revascularization is undertreated due to misconceptions about benefits and historical challenges with percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To critically appraise the literature supporting the rationale, indications, and techniques for revascularizing chronic total occlusions (CTOs).
  • To highlight advancements in percutaneous and surgical approaches for CTO treatment.

Main Methods:

  • Review of current literature on chronic total occlusion (CTO) revascularization.
  • Analysis of percutaneous coronary intervention (PCI) and surgical revascularization techniques and outcomes.

Main Results:

  • Modern percutaneous techniques achieve success rates of approximately 90% for CTO revascularization.
  • State-of-the-art surgical techniques provide complete revascularization with excellent long-term patency.

Conclusions:

  • CTO revascularization is feasible and beneficial, challenging previous misconceptions.
  • Advancements in both percutaneous and surgical interventions have significantly improved success rates and outcomes for patients with CTOs.

Keywords:
Chronic total occlusionCoronary artery bypass graftHybrid revascularizationPercutaneous coronary interventionRevascularization

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