Chronic total occlusions (CTOs) have been called "the last frontier" of percutaneous coronary intervention (PCI) due to traditionally low success rates and high risk for restenosis and re-occlusion. Recent advances in equipment and crossing techniques have significantly increased CTO PCI success rates while maintaining low risk of complications. Specifically, the retrograde approach and controlled antegrade dissection and re-entry in conjunction with advanced guidewires and microcatheters have significantly improved procedural success rates. Moreover, the introduction of the "hybrid" approach has created a unified framework for operators to approach CTOs in a systematic and efficient fashion. Finally, drug-eluting stents, especially second generation, have improved long-term patency after CTO PCI.
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Conflict of Interest Dr. Brilakis is a consulting/speaker honoraria from St. Jude Medical, Terumo, Janssen, Sanofi, Asahi, Abbott Vascular, and Boston Scientific and received research support from Guerbet. His spouse is an employee of Medtronic. Dr. Karmpaliotis was supported by speaker bureau, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Vo is a consultant from Boston Scientific. Dr. Garcia received consulting fees from Medtronic; he is a recipient of a career development award from the VA Office of Research and Development. Dr. Michalis has no conflict of interest. Dr. Alaswad received consulting fees from Terumo and Boston Scientific; he is a consultant, with no financial fees, of Abbott Laboratories. Dr. Doshi received consulting fees from Boston Scientific. Dr. Lombardi is a consultant for Abbott Vascular, Bridgepoint Medical, and Medtronic; speaker honoraria from Abbott Vascular, Medtronic, and Terumo; and equity from Bridgepoint Medical. Dr. Banerjee received research grants from Gilead and the Medicines Company, consultant/ speaker honoraria from Covidien and Medtronic, ownership in MDCARE Global (spouse), and intellectual property in HygeiaTel.
- Chronic total occlusion
- Coronary revascularization
- Percutaneous coronary intervention