title: Advances in the management of coronary chronic total occlusions.
abstract: Chronic total occlusions (CTOs) have been called "the last frontier" of percutaneous coronary intervention (PCI) due to traditionally low success rates and high risk for restenosis and re-occlusion. Recent advances in equipment and crossing techniques have significantly increased CTO PCI success rates while maintaining low risk of complications. Specifically, the retrograde approach and controlled antegrade dissection and re-entry in conjunction with advanced guidewires and microcatheters have significantly improved procedural success rates. Moreover, the introduction of the "hybrid" approach has created a unified framework for operators to approach CTOs in a systematic and efficient fashion. Finally, drug-eluting stents, especially second generation, have improved long-term patency after CTO PCI.
authors.affiliation: VA North Texas Healthcare System, Dallas, TX, USA, esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Minh N
authors.initials: MN
authors.lastname: Vo
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Lampros
authors.initials: L
authors.lastname: Michalis
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.forename: Parag
authors.initials: P
authors.lastname: Doshi
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency