Coronary chronic total occlusions (CTOs) still represent the greatest technical challenge that interventional cardiologists face. CTOs remain seriously undertreated with percutaneous techniques, far below their prevalence. One reason for the low uptake was the suboptimal CTO percutaneous coronary intervention (PCI) success rates over a long period of time. During the last years, dedicated groups of experts in Japan, Europe and United States fostered the development and standardisation of modern CTO recanalisation techniques, along with providing focused training and proctorship worldwide. As a result, dedicated operators achieved success rates far beyond 90 %, while coping with lesions of increasing complexity. A series of studies, mainly retrospective and observational in nature, explored the prognostic impact of CTO PCI, revealing that successful lesion recanalisation is related to improved patient outcome and anginal status; further evidence from randomised trials is on the way. The following review reports on the most recent advances in the field of CTO recanalisation, in an attempt to promote a more balanced approach in patients with chronically occluded coronary arteries and encourage more operators to cope with these inherently complex lesions.
Nikolaos Konstantinidis - National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
Michele Pighi - Division of Cardiology, Cardiovascular Interventions Unit, Department of Medicine, University of Verona
Ismail Dogu Kilic - National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
Roberta Serdoz - National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
Georgios Sianos - 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
Carlo Di Mario - National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
Nikolaos Konstantinidis is grateful to the Hellenic Society of Cardiology for the 2013 research grant.
