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Dobric et al. Vessel Plus 2019;3:26 I http://dx.doi.org/10.20517/2574-1209.2018.77 Page 5 of 7

Figure 1. Indications of CTO revascularization according to symptoms, ischemia and viability. CTO: chronic total occlusions

The role of SYNTAX score is less suitable for evaluating patients with CTO than for non-CTO patients.
CTO lesions are weighted higher (x5) than non-CTO lesions (x2). Therefore, patients with CTOs typically
have much higher scores than those with non-CTO lesions for similar disease distribution. Consequently,
the high SYNTAX scores strengthen the decision to send CTO patients more often to surgery. Since
technical aspects of PCI for CTO have been significantly improved, it might be possible that impact of CTO
[31]
(vs. non-CTO) lesions for SYNTAX score calculation might be overestimated .

CONCLUSION
Finally, we believe that CTO recanalization performed by experienced operator still has place in
interventional practice. The reasonable approach in patient selection would be to take into consideration
the following aspects: the burden of symptoms, the extent of ischemia, and the amount of viable
myocardium in CTO territory.

DECLARATIONS
Authors’ contributions
Conception and design of the study, review of the available literature and drafting of the manuscript:
Dobric M, Stojkovic S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.