The challenges of chronic total coronary occlusions: an old problem in a new perspective.
In spite of the remarkable technological innovation and improved outcomes with percutaneous coronary revascularization, chronic coronary artery total occlusions remain a familiar source of procedural frustration and clinical uncertainty. However, considering the recent development of catheter-based technologies specific for chronic total occlusion (CTO) recanalization and the potential for drug-eluting stents to reduce restenosis and reocclusion, this challenging lesion subset is now recognized as the last formidable barrier to percutaneous revascularization success. Further, consistent observations from more recent clinical trials support successful CTO revascularization to avoid subsequent adverse cardiac events and improve long-term overall survival. This review of total coronary occlusions provides an overview of CTO pathophysiology, describes the procedural and clinical outcomes associated with CTO revascularization, and presents future directions for clinical investigation.
Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, U.S.A. kandz002@mc.duke.edu
David E
DE
Kandzari
D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001161:Arteriosclerosis / Q000503:physiopathology / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation; D002908:Chronic Disease; D003331:Coronary Vessels / Q000473:pathology*; D006801:Humans; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods*; D015607:Stents