Percutaneous Coronary Intervention in Chronic Total Occlusion

Abstract

Percutaneous coronary intervention in chronic total occlusion is a rapidly evolving area, being considered the last frontier of interventional cardiology. In recent years, the development of new techniques and equipment, as well as the training of specialized personnel, increased their success rates, making it the most predictable procedure available. Although the number of randomized and controlled studies is still limited, results from large multicentered registries allow us to safely offer this intervention to patients, as another treatment option along with the optimized drug treatment and myocardial revascularization surgery. This review summarizes the last and most relevant publications in the subject in order to provide an overall view of the field's current status.

Figure 1

J-CTO score: angiographic score used to estimate the probability of success of the procedure. Five variables were analyzed: proximal cap (tapered or blunt), presence of calcification in chronic total coronary occlusions (CTO), presence of angulation greater than 45 degrees within the CTO segment, length of occlusion (greater or equal to 20 mm) and unsuccessful previous approach attempt. The degree of difficulty of the procedure increases the greater the J-CTO score.

Figure 2

Hybrid Algorithm for Crossing Chronic Coronary Occlusions: The hybrid algorithm begins with double coronary injection (Item 1), which allows the evaluation of several angiographic parameters (Item 2) and selection of the type of primary approach: anterograde (Items 3 to 5) or retrograde (Item 6). Changes in strategy are performed (Item 7) depending on the evolution and progress of the procedure.