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Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Coronary Syndrome Hospital Readmission After Perioperative Acute Myocardial Infarction Associated With Noncardiac Surgery Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials Revascularization Strategies in STEMI with Multivessel Disease: Deciding on Culprit Versus Complete-Ad Hoc or Staged Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction Decreased inspired oxygen stimulates de novo formation of coronary collaterals in adult heart 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Association between Coronary Collaterals and Myocardial Viability in Patients with a Chronic Total Occlusion Relationship between therapeutic effects on infarct size in acute myocardial infarction and therapeutic effects on 1-year outcomes: A patient-level analysis of randomized clinical trials Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization
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Review Article2018 Jan 12;7(2).

JOURNAL：J Am Heart Assoc. Article Link

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti P, Brilakis ES. Keywords: chronic total occlusion; complex coronary intervention; percutaneous coronary intervention; stable coronary artery disease

ABSTRACT

Coronary chronic total occlusions (CTOs) are defined as 100% occlusions with TIMI (Thrombolysis in Myocardial Infarction) 0 flow with at least a 3‐month duration. Treatment options for patients with coronary CTOs include lifestyle changes and medications (as is appropriate for all patients with coronary artery disease) and coronary revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In the previous version of the appropriateness use criteria for coronary revascularization, revascularization recommendations were different for patients with and without a coronary CTO, but this is no longer the case in the current (2016 and 2017) versions.


The goal of this review is to summarize the available evidence on the clinical benefits, likelihood of success, risk for complications, and crossing strategies for CTO PCI and provide practical clinical recommendations.
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