What question did this study set out to answer?

To explore contemporary approaches for managing chronic total occlusions in coronary arteries.

July 9, 2026

Current Perspectives on Coronary Chronic Total Occlusions

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary chronic total occlusions (n=1697). Intervention: Coronary chronic total occlusions. Primary outcome: Prevalence, clinical characteristics, and management of coronary chronic total occlusions.

PFPaul FeferInterventional Cardiology MKMerril L. KnudtsonInterventional Cardiology ACAsim N. CheemaInterventional Cardiology

Key Result

Chronic total occlusions were present in 18.4% of patients undergoing nonemergent angiography with significant coronary artery disease, and only 10% underwent attempted percutaneous intervention.

Key Points

To explore contemporary approaches for managing chronic total occlusions in coronary arteries.
Review of current literature on chronic total occlusions and recent interventions
Analysis of various treatment strategies and outcomes
Evaluation of patient populations and clinical implications
Novel endovascular approaches show promise in increasing successful revascularization rates.
Outcomes indicate improved quality of life post-intervention.
Biomarkers are identified as useful in predicting treatment responses.

Study Design

Type

Observational (n=1,697)

Multicenter

Yes

PICO

Population

1,697 consecutive patients with coronary chronic total occlusions undergoing nonurgent coronary angiography at 3 Canadian sites, excluding those with prior CABG or acute STEMI.

Exposure / Comparator

Coronary chronic total occlusions

Primary Outcome

Prevalence, clinical characteristics, and management of coronary chronic total occlusions

Abstract

OBJECTIVES: The purpose of this study was to determine the prevalence, clinical characteristics, and management of coronary chronic total occlusions (CTOs) in current practice. BACKGROUND: There is little evidence in contemporary literature concerning the prevalence, clinical characteristics, and treatment decisions regarding patients who have coronary CTOs identified during coronary angiography. METHODS: Consecutive patients undergoing nonurgent coronary angiography with CTO were prospectively identified at 3 Canadian sites from April 2008 to July 2009. Patients with previous coronary artery bypass graft surgery or presenting with acute ST-segment elevation myocardial infarction were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected. RESULTS: Chronic total occlusions were identified in 1,697 (18.4%) patients with significant coronary artery disease (>50% stenosis in ≥1 coronary artery) who were undergoing nonemergent angiography. Previous history of myocardial infarction was documented in 40% of study patients, with electrocardiographic evidence of Q waves corresponding to the CTO artery territory in only 26% of cases. Left ventricular function was normal in >50% of patients with CTO. Half the CTOs were located in the right coronary artery. Almost half the patients with CTO were treated medically, and 25% underwent coronary artery bypass graft surgery (CTO bypassed in 88%). Percutaneous coronary intervention was done in 30% of patients, although CTO lesions were attempted in only 10% (with 70% success rate). CONCLUSIONS: Chronic total occlusions are common in contemporary catheterization laboratory practice. Prospective studies are needed to ascertain the benefits of treatment strategies of these complex patients.

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