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CTO Revascularization

  • Secondary Prevention and Intervention (D.H. Steinberg, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

CTO revascularization has been a topic of ongoing debate because of its high technical complexity and expected benefits. This review focuses on describing the various strategies for CTO revascularization, associated complications, and their outcomes.

Recent Findings

The hybrid algorithm is the most widely used method for CTO revascularization. The various strategies for CTO crossing are as follows: antegrade wire escalation (AWE), antegrade dissection/re-entry (ADR), and retrograde approach. DECISION-CTO, EURO-CTO, and EXPLORE are the three large randomized trials that studied the impact of complete revascularization with CTO-PCI and conclude that successful CTO-PCI is non-inferior to medical therapy.

Summary

CTO revascularization is a very challenging and complex procedure with a higher risk of complications compared to non-CTO revascularization. With the development of techniques like hybrid algorithm, use of specialized guide wires, drug-eluting stents with low risk of in-stent restenosis, and increased training of operators with increasing procedural volumes, the overall benefits of CTO-PCI revascularization are higher than the complications. CTO-PCI not only can improve overall mortality and survival but also improves angina, reduces burden of ventricular arrhythmia, and reduces the need for subsequent CABG.

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

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Authors and Affiliations

  1. Department of Cardiology, Medical University of South Carolina, 25 Courtenay Drive, Room 7063 ART, Charleston, SC, 29425, USA

    Shailee Y Shah, Jeffery Yourshaw & Anbukarasi Maran

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  1. Shailee Y Shah
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  2. Jeffery Yourshaw
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Correspondence to Anbukarasi Maran.

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Shailee Shah, Jeffery Yourshaw, and Anbukarasi Maran declare that they have no conflict of interest.

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Shah, S.Y., Yourshaw, J. & Maran, A. CTO Revascularization. Curr Cardiovasc Risk Rep 14, 25 (2020). https://doi.org/10.1007/s12170-020-00662-4

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