The Evidence Base for Revascularisation of Chronic Total Occlusions
When patients with ischaemic heart disease are considered for revascularisation the Heart Team’s aim is to
choose a therapy that will provide complete relief of angina for an acceptable procedural risk. Complete functional revascularisation
of ischaemic myocardium is thus the goal and for this reason the presence of a chronic total occlusion
(CTO) - which remain the most technically challenging lesions to revascularise percutaneously - is the most common reason
for selecting coronary artery bypass surgery . From the behaviour of Heart Teams it is clear that physicians believe
that CTOs are important. Yet when faced with patients with CTOs for whom surgery appears excessive (e.g. nonproximal
LAD) or too high risk, there remains a reluctance to undertake CTO PCI, despite significant recent advances in
procedural success and safety and a considerable body of evidence supporting a survival benefit following successful
CTO PCI. This article reviews the relationship between CTOs, symptoms of angina, ischaemia and left ventricular dysfunction
and further explores the evidence relating their treatment to improved quality of life and prognosis in patients
with these features.
Keywords: Chronic total occlusion, coronary, evidence, revascularisation.
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