Contemporary Approach to Chronic Total Occlusion Interventions

  • Mahesh Anantha-Narayanan
  • Santiago GarciaEmail author
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease


Purpose of review

Chronic total occlusion (CTO) poses one of the greatest technical challenges to interventional cardiologists. Despite recent advancements in techniques and clinical trials showing significant benefits of CTO percutaneous coronary interventions (PCI), the proportion of patients with untreated CTOs remains high. We therefore aim to perform a comprehensive review of the various techniques available, recent advancements, benefits, and complications associated with CTO PCI.

Recent findings

Three randomized clinical trials examining the benefits of CTO PCI have recently been presented. Scoring systems have been developed to facilitate pre-procedural estimation of success and complications of CTO PCI. Technological enhancements in coronary wires and other interventional equipment along with dedicated training for CTO operators have improved the likelihood of successful recanalization of CTOs.


CTO PCI has been shown to improve patient symptoms and quality of life. It is therefore important to have an in-depth knowledge of the various CTO techniques, appropriate equipment, and complications when performing these complex procedures. Clinicians should weigh the risks and benefits and choose the appropriate patient population who may benefit from revascularization.


Chronic total occlusions Percutaneous coronary interventions Revascularization Coronary artery disease Coronary angiogram Myocardial infarction 


Compliance With Ethical Standards

Conflict of Interest

Mahesh Anantha Narayanan declares no potential conflicts of interest. Santiago Garcia is a consultant for Surmodics, Osprey medical, Medtronic, Edwards Lifesciences, Abbott and Boston Scientific. Research grants from Edwards Life Sciences, Minnesota Veterans Research Foundation and VA Office of Research and Development.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiovascular Disease, Department of MedicineUniversity of MinnesotaMinneapolisUSA
  2. 2.Minneapolis Heart Institute at Abbott Northwestern HospitalMinneapolisUSA

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