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A Review of Indications and Guidelines of Chronic Total Occlusion Revascularization

Spas Kotev1, Farhad Sami1, Boniface Malangu1

  • 1Department of Cardiology, University of Iowa Health Care, Iowa City, Iowa.

The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
|November 10, 2025
PubMed

Insights

Percutaneous coronary intervention for chronic total occlusion (CTO PCI) effectively relieves angina and improves quality of life in coronary artery disease patients. While successful, long-term benefits on mortality and cardiac function require further investigation.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Chronic total occlusion (CTO) affects 18-30% of coronary artery disease patients.
  • CTO is associated with refractory angina, impaired left ventricular function, and arrhythmias.

Purpose of the Study:

  • To review indications, evidence, and guidelines for CTO revascularization, primarily percutaneous coronary intervention (PCI).
  • To provide clinicians a framework for managing CTO, balancing evidence and patient care.

Main Methods:

  • Synthesis of current literature on CTO revascularization.
  • Review of randomized controlled trials and clinical guidelines (ACC/AHA/SCAI, ESC/EACTS).

Main Results:

  • CTO PCI demonstrates high success rates (>85%) in experienced centers.
  • RCTs indicate improved symptom relief and quality of life post-CTO PCI.
  • Benefits regarding mortality or ventricular function remain unproven.

Conclusions:

  • Current guidelines recommend CTO PCI for refractory angina, stressing operator expertise and shared decision-making.
  • Ongoing research and trials are needed to address controversies in prognostic benefits and patient selection.

Keywords:
chronic total occlusioncoronary angiographycoronary arterycoronary interventionguidelinesindications

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