Key result
Percutaneous angioplasty of chronic total occlusions is associated with low primary success and high restenosis rates, lacking convincing prospective data compared with CABG or medical therapy.
This review highlights the ongoing challenges in percutaneous management of CTOs, including low success rates and high restenosis, emphasizing the need for randomized trials comparing PCI with CABG or medical therapy.
Management of chronic total occlusions (CTOs) remains a challenge for interventional cardiologists. Despite advances in the design of angioplasty hardware and increased operator experience, percutaneous angioplasty of CTO still is associated with a relatively low primary success rate compared with non‐CTO. Although the stent has dramatically improved initial and long‐term outcome, the incidence of restenosis and reocclusion continues to be high in patients with excessive lesion length and/or small vessel size. Adjunctive pharmacotherapy, such as platelet glycoprotein IIb/IIIa receptor antagonist, may play an important role in the prevention of early reocclusion as well as late restenosis. Similarly, radiation therapy may be useful in the prevention/treatment of in‐stent restenosis. Although observational data have shown a poor long‐term survival in patients with CTO, convincing prospective or randomized data are lacking. Future investigations will need to focus on the long‐term outcome of patients with CTO referred for angioplasty compared with CABG or medical therapy.
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Nobuyoshi et al. (1998) conducted a review in Chronic total occlusion. Percutaneous angioplasty vs. CABG or medical therapy was evaluated. Percutaneous angioplasty of chronic total occlusions is associated with low primary success and high restenosis rates, lacking convincing prospective data compared with CABG or medical therapy.
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