Morphological Aspects and Treatment Strategies for Chronic Total Occlusions of the Coronary Arteries.

Coronary total occlusions are routinely found in patients suffering from chronic coronary artery disease. Their prevalence is between 20-50% and is higher in patients with prior coronary artery bypass surgery.  Patients with CTOs have a higher risk profile, higher Syntax scores and in approximately 80% of the cases, a multi-vessel disease. Advances in technology that supports CTO-PCI and the increasing operator experience in high volume centers has raised important questions about the revascularization strategy.  In the majority of cases, the treatment strategy for this group of patients should aim at achieving full revascularization. In this context CABG should be considered the first choice and percutaneous coronary intervention can be considered for patients with less advanced disease. It is not clear, whether successful CTO revascularization (CABG or PCI) have an impact on long-term outcomes. For these reasons, the treatment of patients in the presence of CTOs should be based on the current evidence on the treatment of multivessel coronary disease.