Coronary chronic total occlusions (CTOs) are commonly encountered in patients with coronary artery disease. Compared to patients without coronary CTOs, those with CTO have worse clinical outcomes and lower likelihood of complete coronary revascularisation. Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.
Alfredo Galassi - University of Catania, Catania, Italy
Aaron Grantham - Saint Luke’s Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
David Kandzari - Piedmont Heart Institute, Atlanta, Georgia, US
William Lombardi - University of Washington, Seattle, US
Issam Moussa - Mayo Clinic, Jacksonville, Florida, US
Craig Thompson - Boston Scientific, Natick, Massachusetts, US
Gerald Werner - Klinikum Darmstadt, Darmstadt, Germany
Charles Chambers - Penn State University College of Medicine, Hershey, Pennsylvania, US
Emmanouil Brilakis - VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
The authors would like to thank Ms Sheila Agyeman for her invaluable effort in coordinating the manuscript creation process.
