Thanks to increasing operator experience and development of more sophisticated techniques, CTO PCI is currently achieving high technical and procedural success rates and serves as an efficient alternative to the established approach of these complex lesions (medical therapy or surgery). The high incidence of CTO requires good clinical judgment in the selection of the lesions in need of recanalisation. Recent guidelines have corrected the mistakes from the misinterpretation of trials exploring the clinical benefit of universal recanalisation of recent occlusions after STEMI (Occluded Artery Trial(OAT) trial), responsible for inappropriate restrictions in the use of PCI for these lesions.30 Further technical development is needed to facilitate and simplify the revascularisation techniques, making them both safer and more standardised and predictable. Operator’s ability and centre’s experience play a key role in achieving final success, still highly variable from less than 70 % when bilateral injection, modern dedicated wires and retrograde recanalisation are not used to 80–90 % in an increasing number of high volume dedicated centres. Further evidence, ideally from randomised studies, of clinical benefit of these inherently complex procedures may encourage operators and centres to engage in this challenging endeavour.
Nikolaos Konstantinidis is grateful to the Hellenic Society of Cardiology for the 2013 research grant.