Current evidence base for chronic total occlusion revascularization

Coronary chronic total occlusion (CTO) accounts for an increasing proportion of referrals for percutaneous revascularization. In contrast to acute myocardial infarction, the presence of collaterals and the slow progression of occlusion mandate different considerations when deciding upon revascularization strategies. The identification and referral of CTO lesions continues to grow as the technical success of percutaneous revascularization improves and the evidence base supporting their treatment matures. Preprocedural case examination and strategy planning are becoming routine in the management of CTOs. However, there remains controversy over the indications for recanalizing CTOs and, in particular, the further management of those patients with unsuccessful CTO revascularization attempts. This article will review the evidence for treating CTOs percutaneously.