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Review
. 2018 Jan-Mar;14(1):50-59.
doi: 10.14797/mdcj-14-1-50.

Chronic Total Occlusion Coronary Intervention: In Search of a Definitive Benefit

Alpesh Shah  1
Affiliations
Review

Chronic Total Occlusion Coronary Intervention: In Search of a Definitive Benefit

Alpesh Shah. Methodist Debakey Cardiovasc J. 2018 Jan-Mar.

Abstract

Percutaneous coronary intervention (PCI) of chronic coronary total occlusion is the latest frontier in percutaneous intervention. There are vast improvements in the initial success and safety of the procedure as well as a better understanding of appropriateness and benefits. Advances in technology and skill allow for increased utilization of PCI in cases of chronic coronary total occlusion, with benefits regarding symptoms and quality of life. Percutaneous coronary intervention for chronic coronary total occlusion can correct ischemia and achieve complete revascularization while avoiding traditional coronary bypass grafting, although survival benefits remain unclear.

Keywords: CAD; angina; chronic total occlusion; complete revascularization; interventional cardiology; ischemia; ischemic heart disease; percutaneous coronary intervention.

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Conflict of interest statement

Conflict of Interest Disclosure: Dr. Shah serves in an advisory role for Abbott Vascular, Boston Scientific, Medtronic, and AstraZeneca.

Figures

Figure 1.
Figure 1.
(A, B) Antegrade wire reentry technique using a Stingray (Boston Scientific) balloon in mid LAD (left anterior descending). (C, D) Retrograde wire escalation technique using septal collaterals from circumflex to LAD.
Figure 2.
Figure 2.
Hybrid algorithm for chronic total occlusion percutaneous coronary intervention. Reprinted with permission.
Figure 3.
Figure 3.
(A) Kaplan–Meier survival for patients by residual ischemia, including 0%, 1% to 4.9%, 5% to 9.9%, and ⩾ 10% ischemic myocardium, respectively, after 6 to 18 months of combined percutaneous coronary intervention and optimal medical therapy or optimal medical therapy alone. Reprinted with permission.
Figure 4.
Figure 4.
Mortality in 1,417 patients with STEMI treated with primary percutaneous coronary intervention (*log-rank test for CTO vs no CTO). Reprinted with permission. MVD: multivessel disease; CTO: chronic total occlusion
Figure 5.
Figure 5.
Kaplan-Meier estimates of survival rates in patients with successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) (blue) versus unsuccessful CTO PCI (red). Reprinted with permission.
See this image and copyright information in PMC

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