Treatment of the chronic total occlusion: a call to action for the interventional community.
There is substantial evidence that recanalization of a chronic total occlusion is beneficial; nonetheless, it is generally underutilized in clinical practice. We consider the Aesop's fable of the "Fox and the Grapes" as analogous to the current situation in interventional cardiology. The technical challenges in achieving CTO recanalization has led interventionalists, clinical cardiologists, and sometimes even patients to believe that CTO recanalization is not effective, and, therefore, not needed. This perspective reviews available data regarding efficacy and safety of CTO percutaneous coronary intervention (PCI) in the current drug-eluting stent era, discusses areas where more studies are required, and encourages the interventional community to utilize CTO PCI where appropriate based on current evidence.
San Raffaele Scientific Institute, Milan, Italy.
Mauro
M
Carlino
Caroline J
CJ
Magri
Barry F
BF
Uretsky
Emmanouil S
ES
Brilakis
Simon
S
Walsh
James C
JC
Spratt
Colm
C
Hanratty
J Aaron
JA
Grantham
Stéphane
S
Rinfret
Craig A
CA
Thompson
William L
WL
Lombardi
Alfredo R
AR
Galassi
George
G
Sianos
Azeem
A
Latib
Roberto
R
Garbo
Dimitri
D
Karmpaliotis
David E
DE
Kandzari
Antonio
A
Colombo
D054059:Coronary Occlusion / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome
chronic total occlusions; coronary artery bypass grafting; coronary artery disease; myocardial infarction; percutaneous coronary intervention