Abstract
Chronic total occlusion (CTO) of a coronary artery is typically defined as a completely
occluded artery without any antegrade flow and a duration of at least 3 months. We
reviewed the current literature describing the optimal management of CTO including
the role of revascularization and choice of modality, i.e., percutaneous coronary
intervention (PCI) or coronary artery bypass graft surgery. Databases (PubMed, the
Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL) were searched and relevant
studies of patients with CTO were selected for review. The prevalence of coronary
artery CTOs is approximately 25% among patients undergoing coronary angiography for
angina. Available data suggests that PCI of CTO can be a technically complex procedure
with relatively lower success rates compared with non-CTO PCI and typically associated
with a higher complication rate especially at nonspecialized centers. Furthermore,
successful CTO-PCI is associated with symptomatic improvement but does not appear
to improve mortality, myocardial infarction, stroke, and repeat revascularization
rates. Based on contemporary data, PCI of CTO lesions may be considered in patients
with incapacitating angina despite treatment with optimal guideline-directed medical
therapy and in whom based on coronary anatomy there is a reasonable chance of technical
success with an acceptable risk.
Keywords
chronic total occlusion - percutaneous coronary intervention - complete revascularization
- optimal medical therapy - revascularization
