Update in Chronic Total Occlusion Percutaneous Coronary Interventions

Abstract

Outcomes of chronic total occlusion-percutaneous coronary intervention have significantly improved in recent years. Chronic total occlusion-percutaneous coronary intervention can provide significant clinical benefits, such as angina reduction. At experienced centers, high success rates can currently be achieved, with use of all chronic total occlusion crossing techniques (antegrade wire escalation, antegrade dissection/ reentry, and the retrograde approach) orchestrated by use of procedural algorithms, such as the hybrid algorithm. Growth of chronic total occlusion-percutaneous coronary intervention is also fueled by continuous development of novel equipment, such as guidewires, microcatheters, support catheters, and dissection/reentry equipment. Readiness and ability to treat complications, such as perforation and donor vessel closure, is critical for all centers performing the procedure. Chronic total occlusionpercutaneous coronary intervention is a powerful and continuously developing tool for achieving complete coronary revascularization.

Bivalirudin in percutaneous coronary intervention for chronic total occlusion: A single‐center pilot study

“…With major improvements in interventional equipment and procedural technique during the past decade, the technical and procedural success rates of CTO PCI were significantly improved . However, the procedure remains a high rate of bleeding complications due to a high incidence of coronary perforation and dissection, longer procedure time and great doses of antithrombotic drugs .…”

Interventional Cardiology

“…The development of specialized guidewires, improved antegrade and retrograde techniques and improved patient selection, success has increased to the 80% range in selected patients and a successful procedure is associated with a better long-term outcome. 32,33 However, most patients (30%-50%) are not candidates for PCI given unfavorable anatomy or they would receive incomplete revascularization because of unfavorable anatomy. Improved success in the treatment of chronic total occlusion will require further advances in technology, including real-time imaging of the occluded vessel.…”

Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting?

“…While more patients with CTOs have historically been treated with CABG than PCI, technical advancements in PCI of CTOs may be expected to drive more patients with CTOs towards being treated with PCI. 4 …”

“…44 Indeed, the ability to revascularize CTOs with PCI have improved dramatically in recent years. 4, 45, 46 While the ISCHEMIA trial is randomizing patients prior to the angiogram, most patients will have coronary CT angiograms, which will permit assessment of CTOs, and then comparison of treatment strategies.…”