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Review
. 2024 Mar 27;13(7):1943.
doi: 10.3390/jcm13071943.

Coronary Chronic Total Occlusion Revascularization: When, Who and How?

Elisabetta Ricottini  1 , Federica Coletti  1 , Annunziata Nusca  1   2 , Nino Cocco  1 , Andrea Corlianò  1 , Alessandro Appetecchia  1 , Rosetta Melfi  1 , Fabio Mangiacapra  1   2 , Paolo Gallo  1 , Raffaele Rinaldi  1 , Francesco Grigioni  1   2 , Gian Paolo Ussia  1   2
Affiliations
Review

Coronary Chronic Total Occlusion Revascularization: When, Who and How?

Elisabetta Ricottini et al. J Clin Med. .

Abstract

Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators' techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.

Keywords: complex coronary artery disease; coronary chronic total occlusions; percutaneous coronary interventions.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagnostic and therapeutic work-up in patients presenting with a chronic total occlusion. CTO: chronic total occlusion; LVF: left ventricular function; MI: myocardial infarction; QoL: quality of life; PCI: percutaneous coronary intervention.
Figure 2
Figure 2
Parallel wiring technique.
Figure 3
Figure 3
Proximal CTO cup. (A) Tapered cup with microchannel with a high chance to anterograde success. (B) Stump cup with bridging collaterals with low chance to anterograde success.
Figure 4
Figure 4
Choice of collaterals for retrograde approach. (A) Good interventional septal collaterals from LAD to RCA. (B) No-interventional septal collaterals: there is no connection with the DP of RCA. (C) No-interventional epicardial collaterals: connection with PL ramus of RCA but small and tortuous at high risk of perforations. The arrows show the collateral vessels.
See this image and copyright information in PMC

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