Abstract
Chronic total occlusion (CTO) is a common feature in patients with coronary artery disease (CAD) and is a frequent reason for not proceeding with percutaneous coronary intervention (PCI). Observational data suggest that ischemic reduction from successful CTO PCI improves symptoms, ejection fraction (EF), and long-term clinical survival compared with failure of CTO PCI. Available randomized trial data are limited and have several limitations. Clinically, a CTO imitates a lesion with a fractional flow reserve (FFR) of 0.8 or less. The success rate of CTO PCI has dramatically improved, approaching 90% among experienced operators. Complications are higher with CTO PCI compared with non-CTO PCI; some unique complications are related to retrograde techniques. The hybrid approach in conjunction with CTO-specific guidewires and devices has provided a dramatic improvement in reproducibility and success with CTO PCI.
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