title: Percutaneous revascularization of chronic total occlusions: Rationale, indications, techniques, and the cardiac surgeon's point of view.
abstract: Chronic total occlusions (CTO) are frequently found in clinical practice, yet they are still undertreated, despite the frequent presence of clinical indications for revascularization. The presence of a CTO is a frequent cause of incomplete revascularization, which has been associated with worse long-term outcomes (including mortality), compared to complete revascularization. Such low rates of attempted revascularization can be attributed to a common misconception about the lack of benefit of CTO revascularization, combined with historically lower success rates and higher complication rates of CTO percutaneous coronary intervention. However, modern percutaneous techniques, devices and algorithms now allow successful CTO revascularization in approximately 90% of cases. Additionally, state-of-the-art surgical techniques offer complete revascularization and provide excellent long-term patency rates. The present review provides a critical appraisal of the literature supporting the rationale, indications, modalities and state-of-the-art techniques of CTO revascularization by both percutaneous and surgical approaches.
authors.affiliation: Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: azzalini.lorenzo@hsr.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Torregrossa
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Minneapolis Heart Institute, Minneapolis, MN, USA.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Division of Cardiology, Department of Medicine, New Tokyo Hospital, Chiba, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000592:standards*; D054059:Coronary Occlusion / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D017410:Practice Guidelines as Topic; D066231:Surgeons
keywords: Chronic total occlusion; Coronary artery bypass graft; Hybrid revascularization; Percutaneous coronary intervention; Revascularization