Chronic Total Occlusion Percutaneous Coronary Intervention

Patients with a chronic total occlusion (CTO) often present with stable exertional angina resulting from insufficient blood flow through collaterals to meet myocardial oxygen demand during stress. The objectives of percutaneous coronary intervention (PCI) on these lesions include relief of symptoms, improvement in left ventricular function and remodeling, and potential decrease in mortality. There are currently no randomized trials that have assessed outcomes in patients with CTOs treated with complex PCI compared to medical therapy or coronary artery bypass graft surgery. However, several ongoing investigations aim to evaluate a large range of outcomes and new technology and techniques in CTO PCI, offering the promise of stronger evidence-based guidelines for the care of these complex patients. In this article, we assess the current knowledge regarding prevalence, indications, and outcomes of CTO PCI and provide an up-to-date review of the literature.