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Approach to CTO Intervention: Overview of Techniques

  • Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with significant clinical benefits, but remains technically demanding. Failure to cross the CTO with a guidewire is the most common cause of CTO PCI failure. CTO crossing can be achieved in the antegrade or retrograde direction and can be accomplished by maintaining true lumen position throughout or via subintimal dissection/reentry techniques. A procedural plan should be created prior to the procedure through careful angiographic review of four key parameters: (a) morphology of the proximal occlusion cap; (b) length of the occlusion; (c) quality of the distal vessel and presence of bifurcation at the distal cap; and (d) suitability of collateral circulation for retrograde crossing. Dual coronary injection is recommended in all cases with contralateral collaterals for detailed characterization of the lesion. If one approach fails to progress, a quick transition to the next approach is encouraged to maximize efficacy and efficiency. Procedural complications, including vessel perforation, may occur more frequently in CTO as compared with non-CTO PCI; hence, availability of necessary equipment and expertise in treating such complications are essential.

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References and Recommended Reading

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Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Aris Karatasakis MD, Barbara Anna Danek MD & Emmanouil S. Brilakis MD, PhD

  2. VA North Texas Health Care System, Dallas, TX, USA

    Aris Karatasakis MD, Barbara Anna Danek MD & Emmanouil S. Brilakis MD, PhD

  3. Columbia University Medical Center, New York, NY, USA

    Dimitri Karmpaliotis MD

  4. Henry Ford Hospital, Detroit, MI, USA

    Khaldoon Alaswad MD

  5. Mazankowski Heart Institute, Edmonton, AB, Canada

    Minh Vo MD

  6. San Raffaele Hospital, Milan, Italy

    Mauro Carlino MD

  7. VA San Diego Healthcare System/University of California San Diego, La Jolla, CA, USA

    Mitul P. Patel MD

  8. McGill University Health Centre, Montreal, QC, Canada

    Stéphane Rinfret MD, SM

  9. Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN, 55407, USA

    Emmanouil S. Brilakis MD, PhD

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  1. Aris Karatasakis MD
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  2. Barbara Anna Danek MD
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  4. Khaldoon Alaswad MD
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  5. Minh Vo MD
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  7. Mitul P. Patel MD
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  8. Stéphane Rinfret MD, SM
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  9. Emmanouil S. Brilakis MD, PhD
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Corresponding author

Correspondence to Emmanouil S. Brilakis MD, PhD.

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Conflict of Interest

Aris Karatasakis, Barbara Anna Danek, Minh Vo, and Mauro Carlino each declare no potential conflicts of interest.

Dimitri Karmpaliotis reports personal fees from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions.

Khaldoon Alaswad reports consultant fees from Terumo and Boston Scientific and non-financial consultant for Abbott Laboratories.

Mitul P. Patel reports consulting fees from Abbott Vascular.

Stéphane Rinfret reports grants from Medtronic and Abbott Vascular and personal fees from Boston Scientific.

Emmanouil S. Brilakis reports personal fees from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St. Jude Medical; research grant support from InfraRedx and Boston Scientific; and spouse is an employee of Medtronic.

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.

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This article is part of the Topical Collection on Coronary Artery Disease

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Karatasakis, A., Danek, B.A., Karmpaliotis, D. et al. Approach to CTO Intervention: Overview of Techniques. Curr Treat Options Cardio Med 19, 1 (2017). https://doi.org/10.1007/s11936-017-0501-2

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  • DOI: https://doi.org/10.1007/s11936-017-0501-2

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