Recent Advances in Coronary Chronic Total Occlusions

Abstract

Coronary chronic total occlusions (CTOs) have been a point of interest of the medical community for the last decade. The natural history of CTOs was for a long time unknown, as the presence of a single CTO was the most frequent cause for the exclusion of patients from randomized controlled trials (RCTs). Recent CTO RCTs have failed to show any benefit in terms of hard endpoints as major adverse cardiovascular events, but have shown a significant improvement in quality of life, as well in the frequency of angina; however, these studies are characterized by the limitation of the short duration of their follow-up period. Real-world data from observational studies indicate a significant improvement in cardiovascular death and overall mortality, suggesting that the results depend on the duration of the follow-up, and not on the procedure per se. The aim of the current review is to summarize all the existing RCTs, and to analyze the most important registries, as well as to present the current development of techniques to boost the successful interventional treatment of CTOs.

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

Figure 1

Graphical list of current antegrade and retrograde chronic total occlusion recanalization techniques.

Figure 2

The J-CTO score.

Figure 3

Flowcharts of the randomized controlled trials.