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Angiographic derived endothelial shear stress: a new predictor of atherosclerotic disease progression Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension Parallel Murine and Human Plaque Proteomics Reveals Pathways of Plaque Rupture OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings Flow-Regulated Endothelial S1P Receptor-1 Signaling Sustains Vascular Development Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease Feasibility and efficacy of the ultrashort side branch dedicated balloon in coronary bifurcation stenting Superficial Calcium Fracture After PCI as Assessed by OCT Restricted access Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial
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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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