An update on interventional cardiology: management of CTO, performance of absorbable scaffolds, coronary vasomotion after DES, and antithrombotics

Abstract

In spite of all the progress made over the last decades,1 coronary artery disease remains the most important cause of morbidity and mortality in Western countries2 as well as in the developing world. Atherosclerotic plaques, the underlying cause of the disease, can lead to stenosis or occlusion of epicardial coronary arteries, resulting in ischaemia and angina.3 Acute plaque rupture leads to occlusion and ST-segment myocardial infarction,4 while patients with slowly developing plaques may develop collaterals5 and will therefore present with stable angina rather than infarction even in the presence of coronary occlusion. ![Graphic][1] Coronary chronic total occlusions are commonly encountered in patients undergoing coronary angiography, and their current management is updated in a timely review entitled ‘ Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview ’ by Alfredo Galassi and colleagues from the Cannizzaro Hospital in Catania, Italy.6 Observational studies have demonstrated that successful revascularization of chronic total occlusions is associated with improved quality of life and better outcomes.7–9 However, in the absence of randomized trials, its prognostic benefit remains debatable. Over the past decade, important developments in dedicated equipment and techniques10 have resulted in higher success and lower complication rates. Both European and American guidelines have assigned a class IIa (level of evidence B) recommendation for the percutaneous revascularization of coronary chronic total occlusions. The authors, all experienced operators, stress the importance of appropriate patient selection, and provide a critical assessment of the … [1]: /embed/inline-graphic-1.gif