Chronic total occlusion percutaneous coronary intervention in clinical practice: novel grounds to be EXPLOREd

Randomized Controlled Comparison of Optimal Medical Therapy with Percutaneous Recanalization of Chronic Total Occlusion (COMET-CTO)

“…The EXPLORE (Evaluating Xience and Left Ventricular Function in PCI on Occlusions After STEMI) trial included 304 patients who had non-culprit CTO at the time of initial diagnosis of ST segment elevation MI. 7,23) After successful recanalization of the culprit lesion, patients were randomized to OMT with CTO PCI or OMT alone. PCI of CTO proved to be convenient and safe; however, no significant clinical benefits and improvements in the LVEF or left ventricular end-diastolic volume were observed.…”

Bilateral Distal Radial Artery Access for Percutaneous Coronary Intervention for Chronic Totally Occluded Left Anterior Descending Artery

“…Chronic total occlusion percutaneous coronary intervention still represents the most challenging settings for percutaneous coronary intervention, with recent optimal procedural success obtained thanks to advance in tools and techniques. In recent years, successful percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) of the coronary arteries has been achieved through improvement of guidewires [1] and supportive devices [2,3]. In addition, successful CTO re-canalisation has been demonstrated to relieve ischaemic symptoms, improve left ventricular (LV) function and improve long-term survival.…”

Heartbeat: The ongoing controversy of intervention for chronic total coronary occlusions

“…In the accompanying editorial, Stojkovic and Milasinovic2 point out that the rational for CTO-PCI ‘rests on the notion of achieving percutaneous complete revascularisation in patients with significant coronary artery disease as incomplete revascularisation has been linked to impaired prognosis.’ Although the editorial indicates that ‘the authors of the EXPLORE trial are to be congratulated for completing one of the pioneering randomised studies of PCI versus conservative strategy for CTO,’ they also express concerns about several limitations of the study design. They go on to recommend that in addition to ongoing randomised trials of CTO, ‘potential novel grounds may be explored to accumulate evidence regarding optimal CTO treatment, such as (1) enlarging the network of peers capable of performing high-quality CTO PCI with success rates >90% through dedicated proctoring programmes, (2) standardising procedural and outcome reporting to facilitate comparisons among trials and creation of large databases and (3) investigating the effects of CTO PCI in specific disease subsets, such as low EF, where significant improvements have been shown in an observational setting.’…”