Section E
Clinical Summary and Recommendations
The aim of revascularisation in CTOs is to improve symptoms and/or prognosis, thus recanalisation attempt of a CTO should be considered in the presence of symptoms or objective evidence of viability/ ischaemia in the territory of the occluded artery.
In the 2011 American College of Cardiology/American Heart Association PCI guidelines, CTO PCI carries a class IIA recommendation: “PCI of a CTO in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate expertise”.96 The 2010 European Society of Cardiology state that “similar to nonchronically occluded vessels, revascularisation of CTO may be considered in the presence of angina or ischaemia related to the corresponding territory”.97 In the 2012 statement on Appropriate Use Criteria for Coronary Revascularisation, coronary revascularisation was given a lower level recommendation compared with patients with 1–2 vessel CAD without a CTO in 5 of 18 assessed clinical scenarios.25 It is the authors’ opinion that the presence of a CTO should not have an impact on the revascularisation decision, as long as appropriate expertise in CTO PCI is locally available.
The authors would like to thank Ms Sheila Agyeman for her invaluable effort in coordinating the manuscript creation process.