Can coronary computed tomography angiography be the complete roadmap for chronic total occlusion management

The incidence of chronic total occlusion (CTO) is reported to be as high as 25%, at least in individuals referred to invasive coronary angiography (ICA).1 In this scenario, CTO is also associated with a high mortality and Major Adverse Cardiac Events (MACE) incidence.1 Interestingly, this incidence of events is reported to be high even after the clinical profile and extent of coronary artery disease (CAD) in other vessels is accounted for.2 This relatively high prevalence and disproportionate rate of events has driven the attention of the interventional cardiologists in a quest to improve prognosis in the CTO setting. However, individuals referred for ICA represent a selected population of the individuals with suspected or known CAD, and the actual prevalence and event rates associated with CTO might be significantly lower if a less selected population is studied. Coronary CT angiography (CTA) has been increasingly used in the investigation of suspected CAD. Over the last two decades, it has proven to provide adequate diagnostic and prognostic information for the presence, extent and severity of CAD.3 4 Recent evidence also suggests it can also have a meaningful impact on the management of CAD.5 6 More specifically, recent reports even suggest that coronary CTA might be useful for interventional procedural guidance in CTO.7 However, more comprehensive data on CTO detected …