title: Chronic total coronary occlusion recanalization: Current techniques and new devices.
abstract: Percutaneous coronary intervention (PCI) of total chronic coronary occlusion (CTO) still remains a major challenge. The prevalence of a CTO has been reported to be up to 30% among patients with a clinical indication for coronary angiography. Progress has been made with further advanced interventional techniques and continuously sophisticated interventional tools. Nevertheless the number of interventions carried out to recanalize a CTO is less than 10% of all procedures. Benefits of a successful CTO recanalization include relief of angina pectoris and ischemia-related dyspnea, substantial improvement in left ventricular function and, avoidance of surgery treatment. A vast variety of new CTO PCI techniques and materials has been introduced into clinical practise and pushed success rates of reopening a CTO up to around 90% in experienced hands. Particulary the introduction of the retrograde technique was a milestone. New developed microcatheters and special polymer coated wires allow to recanalize via small collaterals and vessels. Other tools such as intravascular ultrasound (IVUS) and multislice computertomography (MSCT) help to identify the anatomy and the characteristic of the lesions. Any invasive cardiac center should adopt CTO PCI procedures as standard therapy.
  
  
  OBJECTIVE
  This review wants to assess and describe the latest development in CTO recanalization strategies.
authors.affiliation: Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Gülker
authors.affiliation: Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany.
authors.forename: Lars
authors.initials: L
authors.lastname: Bansemir
authors.affiliation: Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany.
authors.forename: Heinrich G
authors.initials: HG
authors.lastname: Klues
authors.affiliation: Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany; Witten/Herdecke University, Witten, aGermany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bufe
keywords: Chronic total occlusion; Coronary artery disease; Latest development; Recanalization strategies; Technical innovation