Outcomes following successful recanalization of chronic total coronary occlusions

A chronically occluded coronary lesion is observed in approximately 20–30% of patients in whom the diagnosis of coronary artery disease is established by coronary angiography. By contrast, a chronic total coronary occlusion (CTO) as a target of a percutaneous coronary intervention (PCI) constitutes less than 10% of the PCI volume in current practice. This discrepancy is explained in part by the specific technical challenges posed by a CTO with a low primary success rate, and a high lesion recurrence rate. The latter is addressed by the use of drug-eluting stents, and the former is improved considerably with recent technical advancements and specialization of operators. There are three principal indications to revascularize a CTO, which are the relief of clinical symptoms, the improvement of impaired left ventricular function, and a potential improvement in survival. Despite the absence of a randomized clinical comparison between conservative and interventional treatment of CTOs, numerous nonrandomized stu...