Coronary intervention for chronic total occlusion: current indications and future directions
Chronic total occlusions (CTOs) are routinely encountered during coronary angiography, but subsequent revascularization rates are low. This has likely been driven by a historical belief that there is minimal clinical benefit and poor success rates with a percutaneous coronary intervention (PCI). However, in the current era, with the development of new techniques and tools, experienced operators can perform CTO-PCI successfully in the majority of patients. The current indications and benefit of CTO-PCI remain a topic of controversy and debate. There is a growing body of predominantly nonrandomized studies reporting both short-term and long-term outcomes of CTO-PCI. Recent and upcoming randomized-controlled trials in this area will also potentially expand indications in both stable and patients with acute coronary syndrome. In this review, we will discuss the current evidence for CTO-PCI and also future directions in this field.