title: Contemporary overview and clinical perspectives of chronic total occlusions.
abstract: Chronic total occlusions (CTOs) are often detected on diagnostic coronary angiograms, but percutaneous coronary intervention (PCI) for CTO is currently infrequently performed owing to high technical difficulty, perceived risk of complications, and a lack of randomized data. However, successful CTO-PCI can significantly increase a patient's quality of life, improve left ventricular function, reduce the need for subsequent CABG surgery, and possibly improve long-term survival. A number of factors must be taken into account for the selection of patients for CTO-PCI, including the extent of ischaemia surrounding the occlusion, the level of myocardial viability, coronary location of the CTO, and probability of procedural success. Moreover, in patients with ST-segment elevation myocardial infarction, a CTO in a noninfarct-related artery might lead to an increase in infarct area, increased end-diastolic left ventricular pressure, and decreased left ventricular function, which are all associated with poor clinical outcomes. In this Review, we provide an overview of the anatomy and histopathology of CTOs, perceived benefits of CTO-PCI, considerations for patient selection for this procedure, and a summary of emerging techniques for CTO-PCI.
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Loes P
authors.initials: LP
authors.lastname: Hoebers
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.affiliation: Mount Sinai Medical Center, Department of Cardiology, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: Sahlgrenska University Hospital, Department of Cardiology, Per Dubbsgatan 15, 413 45 Gothenburg, Sweden.
authors.forename: Truls
authors.initials: T
authors.lastname: Råmunddal
authors.affiliation: Mount Sinai Medical Center, Department of Cardiology, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
mesh_terms: D002908:Chronic Disease; D054059:Coronary Occlusion / Q000473:pathology / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016896:Treatment Outcome