Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions

Abstract

Approximately 1 in 4 patients with obstructive coronary artery disease on coronary angiography had CTOs. Among patients who went on to elective CTO PCI, the success rate was 79.7%. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality as well as a decreased need for subsequent coronary artery bypass graft surgery.

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

“…In recent years, several large multicenter registries have reported higher success (≈85%–90%) with acceptable complication rates in CTO PCI at various experienced centers and with operators from all around the world, although less optimal results have been reported from all‐comer PCI registries (Table 2). 8, 25, 26, 27, 28, 29, 30, 31, 32 …”

“…Tsai et al31 examined 111 273 patients who underwent coronary angiography at 79 Veterans Affairs centers and were included in the Veterans Affairs Clinical Assessment Reporting and Tracking program. At least one CTO was found in 26.4% of all patients (n=29 399), of whom 8.1% underwent CTO PCI.…”

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

“…Although chronic total occlusions (CTOs) are a common coronary angiographic finding, with an incidence reaching >25%, a disproportionately smaller portion of patients are treated with percutaneous coronary intervention (PCI), comprising 8% of the overall PCI volume 1. There appear to be at least two important issues that are associated with the existing discrepancy between the occurrence of CTO and the rate of CTO PCI in contemporary clinical practice.…”

“…First, percutaneous CTO recanalisation is often considered to be technically difficult, resource-demanding and time-demanding, with a complication rate exceeding that of a non-CTO PCI. However, recent advances in the interventional technique, both antegrade and retrograde, including the hybrid algorithm, have resulted in >90% procedural success rates, while being associated with a low occurrence of major complications, such as cardiac tamponade, myocardial infarction and death (all well below 1%) 1. Second, the evidence base regarding clinical benefits of CTO PCI over medical therapy has largely been confined to observational data, stemming mainly from retrospective comparisons of clinical outcomes in patients with successful versus failed CTO PCI,1 whereas randomised studies evaluating the effects of PCI versus medical therapy for CTO have been scarce.…”

“…However, recent advances in the interventional technique, both antegrade and retrograde, including the hybrid algorithm, have resulted in >90% procedural success rates, while being associated with a low occurrence of major complications, such as cardiac tamponade, myocardial infarction and death (all well below 1%) 1. Second, the evidence base regarding clinical benefits of CTO PCI over medical therapy has largely been confined to observational data, stemming mainly from retrospective comparisons of clinical outcomes in patients with successful versus failed CTO PCI,1 whereas randomised studies evaluating the effects of PCI versus medical therapy for CTO have been scarce. Notwithstanding the currently insufficient randomised evidence base, the clinical appeal of CTO PCI seems to, at least in part, rest on the notion of achieving percutaneous complete revascularisation in patients with significant coronary artery disease as incomplete revascularisation has been linked to impaired prognosis 2…”