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Current evidence base for chronic total occlusion revascularization

H Douglas, NG Johnston, AJ Bagnall & SJ Walsh

Chronic total occlusion (CTO) is defined as when atherosclerotic coronary artery disease (CAD) produces the complete or almost complete obstruction of flow in an epicardial vessel for a period of 3 months or greater. Successful revascularization of CTOs is associated with improvement in symptoms, quality of life and prognosis. The safety and success of percutaneous treatment of CTO has increased in recent years, particularly with the advent of hybrid approaches combining antegrade, retrograde and limited subintimal methods. Although no randomized controlled trial data directly comparing different treatment strategies are available, this review will summarize the available data supporting the use of CTO percutaneous coronary intervention (PCI) to improve patient outcomes.