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Dobric et al. Vessel Plus 2019;3:26 Vessel Plus
DOI: 10.20517/2574-1209.2018.77

Review Open Access

Contemporary indications for percutaneous
revascularization of coronary chronic total
occlusions

Milan Dobric , Sinisa Stojkovic 1,2
1,2
1 Clinic for Cardiology, Clinical Center of Serbia, Belgrade 11000, Serbia.
2 Clinic for Cardiology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia .
Correspondence to: Prof. Sinisa Stojkovic, Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine,
University of Belgrade, Visegradska 26, Belgrade, 11000, Serbia. E-mail: sstojkovi@mts.rs

How to cite this article: Dobric M, Stojkovic S. Contemporary indications for percutaneous revascularization of coronary chronic
total occlusions. Vessel Plus 2019;3:26. http://dx.doi.org/10.20517/2574-1209.2018.77

Received: 22 Jan 2019 First Decision: 29 Apr 2019 Revised: 8 May 2019 Accepted: 17 Jul 2019 Published: 7 Aug 2019

Science Editors: Alfredo R. Galassi, Marouane Boukhris Copy Editor: Jia-Jia Meng Production Editor: Tian Zhang

Abstract
Chronic total occlusions (CTO) are frequently encountered during coronary angiography, and are generally
regarded as the most challenging coronary lesions for percutaneous coronary intervention (PCI). Despite great
technical advancements and greatly improved reported procedural success rates during previous years, data on
clinical benefit of these procedures still remain scarce and controversial. Data from observational trials suggested
that PCI for CTO could be linked to improvements both in symptoms and hard cardiovascular outcomes, while
randomized controlled trials showed symptomatic improvement only, without improvement in patient’s prognosis.
This is in parallel with findings for non-CTO PCI in patients with stable angina. Having in mind complexity of these
interventions, high costs, greater volume of contrast, and radiation exposure, appropriate patient selection is crucial
for optimizing treatment effectiveness. There are few important factors that should be taken into consideration
before planning and attempting PCI for CTO. These are: severity of patient’s symptoms despite optimal medical
therapy, presence of inducible myocardial ischemia and/or viability in the territory of occluded coronary artery.

Keywords: Chronic total occlusion, percutaneous coronary intervention, indications for intervention

INTRODUCTION
Chronic total occlusions (CTO) of coronary artery is defined as an occluded coronary vessel with
[1,2]
thrombolysis in myocardial infarction flow 0, that lasts for 3 months or more . They are often found

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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