Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May;10(2):99-107.
doi: 10.2174/1573403x10666140331142349.

CTO pathophysiology: how does this affect management?

John Irving  1
Affiliations
Review

CTO pathophysiology: how does this affect management?

John Irving. Curr Cardiol Rev. 2014 May.

Abstract

Chronic total occlusion (CTO) pathophysiology has been described in a few, small studies using post mortem histology, and more recently, in vivo intravascular ultrasound (IVUS) to analyse the constituents of occluded segments. Recent improvements in equipment and techniques have revealed new insights into physical characteristics of occluded coronaries, which in turn enable predictable procedural success. The purpose of this review is to consider the published evidence describing CTO pathophysiology from the perspective of the hybrid algorithm approach to CTO PCI.

Methods: Literature searches using "Chronic Occlusion", "angioplasty", and" pathology" as keywords. Further searches on "coronary" "collateral", "Viability". Bibliographies were scrutinised for further key publications in an iterative process. Papers describing animal models were excluded.

PubMed Disclaimer

Figures

Fig. (1)
Fig. (1)
Image of coronary angiogram of RCA from late presenting STEMI. Normal LV function. Bulky thrombotic occlusion extending to small calibre marginal branch.
Fig. (2)
Fig. (2)
Coronary angiogram following aspiration thrombectomy. Culprit lesion 15mm distal to proximal margin of occlusive thrombus.
Fig. (3)
Fig. (3)
Still from angiogram of CTO of circumflex. Epicardial collaterals from diagonal. Symptoms predated this investigation by 6 months.
Fig. (4)
Fig. (4)
Still from PCI procedure, 1 year following angiogram in (Fig. 3). Long tapered segment replaced by blunt stump.
Fig. (5)
Fig. (5)
Still from coronary angiogram recorded during PCI in 2013 from patient in whom angina recurred 18 years post CABG. The occlusion of the RCA was reported on coronary angiography in 1993.
Fig. (6)
Fig. (6)
Coronary angiography of final result following successful PCI. 20 year old lesion crossed by antegrade wire escalation techniques.
See this image and copyright information in PMC

References

    1. Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. The Am J Cardiol. 2005;95(9):1088–91. - PubMed
    1. Werner GS, Gitt AK, Zeymer U , et al. Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol. 2009;98(7):435–41. - PubMed
    1. Fefer P, Knudtson ML, Cheema AN , et al. Current Perspectives on Coronary Chronic Total OcclusionsThe Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012;59(11):991–7. - PubMed
    1. Levin D. Pathways and functional significance of the coronary collateral circulation. Circulation. 1974;50(4):831–7. - PubMed
    1. Tubbs RS, Loukas M, Shoja MM, Ardalan MR, Oakes WJ. Richard Lower (1631-1691) and his early contributions to cardiology. Int J Cardiol. 2008;128(1):17–21. - PubMed