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Review
. 2022 Jan 10;15(1):1-21.
doi: 10.1016/j.jcin.2021.09.027.

Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention

Lorenzo Azzalini  1 , Dimitri Karmpaliotis  2 , Ricardo Santiago  3 , Kambis Mashayekhi  4 , Carlo Di Mario  5 , Stéphane Rinfret  6 , William J Nicholson  6 , Mauro Carlino  7 , Masahisa Yamane  8 , Etsuo Tsuchikane  9 , Emmanouil S Brilakis  10
Affiliations
Free article
Review

Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention

Lorenzo Azzalini et al. JACC Cardiovasc Interv. .
Free article

Abstract

Remarkable progress has been achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent years, with refinement of the indications and technical aspects of the procedure, imaging, and complication management. Randomized controlled trials and rigorous prospective registries have provided high-quality data on the benefits and risks of CTO PCI. Global collaboration has led to an agreement on nomenclature, indications, endpoint definition, and principles of clinical trial design that have been distilled in global consensus documents such as the CTO Academic Research Consortium. Increased use of preprocedural coronary computed tomography angiography and intraprocedural intravascular imaging, as well as development of novel techniques and structured CTO crossing and complication management algorithms, allow a systematic, stepwise approach to this difficult lesion subset. This state-of-the-art review provides a comprehensive discussion about the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO PCI.

Keywords: CTO; coronary chronic total occlusion; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Azzalini has received honoraria from Teleflex, Abiomed, Asahi Intecc, Philips, Abbott Vascular, and Cardiovascular Systems, Inc. Dr Karmpaliotis has received honoraria from Boston Scientific and Abbott Vascular; and has equity in Saranas, Traverse Vascular, and Soundbite. Dr Santiago has received speaker and proctoring honoraria from Boston Scientific, Abbott Vascular, and Teleflex. Dr Mashayekhi has received consulting, speaker, and proctoring honoraria from Abbott Vascular, Ashai Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi-Sankyo, Medtronic, Teleflex, and Terumo. Dr Di Mario has received research grants from Amgen, Behring, Boston Scientific, Chiesi, Daiichi-Sankyo, Edwards Lifesciences, Medtronic, Shockwave Medical, and Volcano/Philips. Dr Rinfret has received consulting honoraria from Boston Scientific, Teleflex, Abbott Vascular, Medtronic, and Soundbite Medical. Dr Nicholson has received proctoring and advisory board honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Asahi Intecc. Dr Tsuchikane has received consulting honoraria from Asahi Intecc, Kaneka, Nipro, and Boston Scientific. Dr Brilakis has received consulting and speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, Cardiovascular Systems, Inc, Elsevier, GE Healthcare, IMDS, InfraRedx, Medicure, Medtronic, Opsens, Siemens, and Teleflex; is an owner of Hippocrates; and is a shareholder in MHI Ventures and Cleerly Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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