title: Theory and practical based approach to chronic total occlusions.
abstract: Coronary chronic total occlusions (CTOs) represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. The complexity of these procedures and the suboptimal success rates over a long period of time, along with the perception that CTOs are lesions with limited scope for recanalization, account for the underutilization of CTO Percutaneous Coronary Intervention (PCI). During the last years, dedicated groups of experts in Japan, Europe and United States fostered the development and standardization of modern CTO recanalization techniques, achieving success rates far beyond 90%, while coping with lesions of increasing complexity. Numerous studies support the rationale of CTO revascularization following documentation of viability and ischemia in the territory distal to the CTO. Successful CTO PCI provide better tolerance in case of future acute coronary syndromes and can significantly improve angina and left ventricular function. Randomized trials are on the way to further explore the prognostic benefit of CTO revascularization. The following review reports on the theory and the most recent advances in the field of CTO recanalization, in an attempt to promote a more balanced approach in patients with chronically occluded coronary arteries.
authors: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece. gsianos@auth.gr.
authors: Georgios
authors: G
authors: Sianos
authors: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece. nikos.konstantinidis@hotmail.com.
authors: Nikolaos V
authors: NV
authors: Konstantinidis
authors: National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. c.dimario@rbht.nhs.uk.
authors: Carlo
authors: C
authors: Di Mario
authors: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece. hkarvounis@hotmail.com.
authors: Haralambos
authors: H
authors: Karvounis
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016277:Ventricular Function, Left