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Management of Chronic Total Occlusion Percutaneous Coronary Intervention Complications

Anna Subramaniam1, William L Lombardi1

  • 1Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.

Interventional Cardiology Clinics
|November 23, 2025
PubMed

Insights

Managing complications during complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is crucial. This review outlines systematic approaches for recognizing and treating major CTO PCI complications to ensure patient safety.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine
  • Medical Device Technology

Background:

  • Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex cardiovascular procedure.
  • CTO PCI has high success rates but carries higher complication risks than non-CTO PCI.

Purpose of the Study:

  • To provide systematic management strategies for major complications encountered during CTO PCI.
  • To enhance patient safety in challenging interventional cardiology procedures.

Main Methods:

  • Systematic review of major CTO PCI complications and their management.
  • Analysis of complication rates including coronary perforation, donor vessel injury, and equipment entrapment.
  • Outline of key principles for complication recognition and intervention.

Main Results:

  • Coronary perforation occurs in 3.8% of CTO PCI procedures.
  • Donor vessel injury occurs in 0.35% of CTO PCI procedures.
  • Equipment entrapment occurs in 0.4% of CTO PCI procedures.

Conclusions:

  • Early recognition and prompt intervention are vital for managing CTO PCI complications.
  • Effective complication management necessitates preparedness, including emergency equipment and trained personnel.
  • Sound clinical judgment is essential for optimizing patient outcomes in complex CTO PCI cases.

Keywords:
Chronic total occlusionComplex interventionComplications

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