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. 2024 Feb 5;20(3):e174-e184.
doi: 10.4244/EIJ-D-23-00749.

Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery

Alfredo R Galassi  1 , Giuseppe Vadalà  1 , Gerald S Werner  2 , Bernard Cosyns  3 , Georgios Sianos  4 , Jonathan Hill  5 , Dariusz Dudek  6 , Eugenio Picano  7 , Giuseppina Novo  1 , Daniele Andreini  8 , Bernhard L M Gerber  9 , Ronny Buechel  10 , Kambis Mashayekhi  11 , Mathias Thielmann  12 , Margaret B McEntegart  13 , Beatriz Vaquerizo  14 , Carlo Di Mario  15 , Sinisa Stojkovic  16 , Sigrid Sandner  17 , Nikolaos Bonaros  18 , Thomas F Lüscher  5   19
Affiliations

Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery

Alfredo R Galassi et al. EuroIntervention. .

Abstract

Chronic total occlusions (CTOs) of coronary arteries can be found in the context of chronic or acute coronary syndromes; sometimes they are an incidental finding in those apparently healthy individuals undergoing imaging for preoperative risk assessment. Recently, the invasive management of CTOs has made impressive progress due to sophisticated preinterventional assessment, including advanced non-invasive imaging, the availability of novel and dedicated tools for CTO percutaneous coronary intervention (PCI), and experienced interventionalists working in specialised centres. Thus, it is crucial that referring physicians who see patients with CTO be aware of recent developments and of the initial evaluation requirements for such patients. Besides a careful history and clinical examination, electrocardiograms, exercise tests, and non-invasive imaging modalities are important for selecting the patients most suitable for CTO PCI, while others may be referred to coronary artery bypass graft or optimal medical therapy only. While CTO PCI improves angina and reduces the use of antianginal drugs in patients with symptoms and proven ischaemia, hibernation and/or wall motion abnormalities at baseline or during stress, the effect of CTO PCI on major cardiovascular events is still controversial. This clinical consensus statement specifically focuses on referring physicians, providing a comprehensive algorithm for the preinterventional evaluation of patients with CTO and the current evidence for the clinical effectiveness of the procedure. The proposed care track has been developed by members and with the support of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI), and the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery.

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Conflict of interest statement

N. Bonaros: Medtronic and Edwards Lifesciences; B. Cosyns: research funding from Abbott; C. Di Mario: Boston Scientific, Medtronic, Behring, Idorsia, Philips, Shockwave Medical, Edwards Lifesciences; D. Z. Dudek: Abbott, Balton, Mac's Medical, Chemie AG, Ferrer Internacional, Aspironix, Abiomed, Hemolens, AstraZeneca, Biotronik, Boston Scientific, Bracco Pharmaceutical, Edwards Lifesciences, GE HealthCare, Medtronic, Procardia, B. Braun, Teleflex, Sanofi Aventis, Philips, SMT, Gedeon Richter, Cardinalhealth, Siemens Healthcare, Terumo Inc; B.L.M. Gerber: Pfizer, Daiichi Sankyo, Bristol-Myers Squibb, Sanofi Aventis; J. Hill: Abbott Vascular, Shockwave Medical, Neovasc, Boston Scientific, Abiomed; T.F. Lüscher: Acthera, Daiichi Sankyo, Amgen, Novartis, Boehringer-Ingelheim, Philips, e-therapeutics, Open Health, Novo Nordisk, AstraZeneca, Vifor International, Abbott; M. McEntegart: Boston Scientific, Teleflex, Shockwave Medical, Medtronic, Biosensors; B. Vaquerizo Montilla: Boston Scientific, Medtronic, Lifetech; G.S. Werner: Abbott Vascular, Daiichi Sankyo, Shockwave Medical, Terumo Inc, Siemens Healthcare, Philips, Orbus, Asahi. The other authors have no conflicts of interest to declare.

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