Chronic Total Occlusion Percutaneous Coronary Intervention
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SECONDARY PREVENTION AND INTERVENTION (D. STEINBERG, SECTION EDITOR)
Chronic Total Occlusion Percutaneous Coronary Intervention Christine J. Chung 1 & Matthew T. Finn 2 & Raja Hatem 1 & Philip Green 1 & Ajay J. Kirtane 3 & Dimitri Karmpaliotis 3
Published online: 26 November 2016 # Springer Science+Business Media New York 2016
Abstract Patients with a chronic total occlusion (CTO) often present with stable exertional angina resulting from insufficient blood flow through collaterals to meet myocardial oxygen demand during stress. The objectives of percutaneous coronary intervention (PCI) on these lesions include relief of symptoms, improvement in left ventricular function and remodeling, and potential decrease in mortality. There are currently no randomized trials that have assessed outcomes in
This article is part of the Topical Collection on Secondary Prevention and Intervention * Dimitri Karmpaliotis [email protected] Christine J. Chung [email protected] Matthew T. Finn [email protected] Philip Green [email protected] Ajay J. Kirtane [email protected] 1
Department of Medicine-Cardiology, Columbia University Medical Center, 161 Fort Washington Avenue, HIP 6-610, New York, NY 10032, USA
2
Division of Cardiology, Department of Medicine-Cardiology, Assistant in Clinical Medicine, Columbia University Medical Center, RBP - 1150St Nicholas Avenue, New York, NY 10032, USA
3
Center for Interventional Vascular Therapy, Department of Medicine-Cardiology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
patients with CTOs treated with complex PCI compared to medical therapy or coronary artery bypass graft surgery. However, several ongoing investigations aim to evaluate a large range of outcomes and new technology and techniques in CTO PCI, offering the promise of stronger evidence-based guidelines for the care of these complex patients. In this article, we assess the current knowledge regarding prevalence, indications, and outcomes of CTO PCI and provide an upto-date review of the literature. Keywords Chronic total occlusion . Complex percutaneous coronary intervention . Outcomes . Review
Introduction A chronic total occlusion (CTO) is defined as a 100 % obstructive coronary lesion present for at least 3 months with less than or equal to Thrombosis in Myocardial Infarction (TIMI) grade I flow. The estimated prevalence of chronic total occlusions (CTOs) is around 30 % in high-risk patients referred for coronary angiography [1, 2]. Patients with a CTO often have stable exertional angina resulting from insufficient blood flow through collaterals to meet myocardial oxygen demand during stress [3]. In addition to management of symptoms, referral for percutaneous coronary intervention (PCI) may be prompted by significant ischemia on noninvasive imaging. In this article, we provide an appraisal of current knowledge regarding the prevalence, success rates, indications, and outcomes of CTO PCI. We also examine specific management scenarios in CTO PC
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