Current considerations regarding the percutaneous revascularization of chronic total coronary occlusions

Chronic total coronary artery occlusions are commonly encountered, occurring in 15–33% of patients in the angiography suite. Reasons to consider percutaneous coronary revascularization of these lesions include the relief of angina, enhancement of left ventricular ejection fraction and the potential for improved survival. Owing to the complex nature of these lesions, attempts at percutaneous revascularization have traditionally been infrequent (≤12%of encountered cases). Advances in technique and equipment have resulted in improved success rates that now approach 90% at specialized centers. It remains to be seen if these positive results can be achieved by the interventional cardiology community at large.