Update on percutaneous coronary intervention in the management of chronic total occlusions

The management of chronic total coronary occlusions (CTO) is still today one of the greatest challenges of cardiology. The complexity of the angioplasty procedure of a CTO added to its controversial clinical benefits has generated certain skepticism in the community of cardiologists when developing CTO intervention programs at the catheterization laboratory. However, the evidence from observational studies indicates that if the intervention is successful it can significantly increase the patient's quality of life, improve the left ventricular function, reduce the need for a subsequent coronary artery bypass graft, and possibly improve survival. Several factors must be taken into consideration in the selection of patients elective for an intervention, including the extent of ischemia surrounding the occlusion, the myocardial viability, the coronary location of the CTO, and the chances of being successful with the procedure. This review provides a general description of the anatomy and histopathology of the CTOs, the evidence surrounding the clinical benefit of these procedures, the use of useful scoring systems to assess more objectively the probability of success, and a summary of the latest techniques available today to perform this procedure.