Coronary Chronic Total Occlusions
Time to Abandon a Culture of Therapeutic Nihilism?
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There is a renewed and growing interest in the chronic total occlusions (CTO) percutaneous coronary intervention (PCI) field, driven by the dissemination of advanced CTO PCI techniques and new innovative technologies, all of which have translated to higher success rates with an acceptable complication profile. However, CTO PCI remains a highly technical and demanding interventional subspecialty that is strongly operator dependent. There is a steep learning curve and a clear volume to outcome relationship with high-volume centers with dedicated CTO operators have higher success rates, ranging from 70% to 90%.1 Balanced against this improved success, CTO PCI continues to have a higher risk for complications compare to non-CTO PCI.2 Therefore, there is substantial variation between hospitals in the approach to revascularization of patients with CTO lesions, in particular with percutaneous modalities, with a range from 44.9% to 94.1%.3 Moreover, when PCI is attempted in general yet contemporary PCI practice, successful stenting of the PCI lesion is a paltry 41.1%. Indeed, the reticence to treat CTO is ingrained in practice guidelines, with a different set of guideline recommendations for CTO versus non-CTO anatomy, even in the presence of similar ischemic burden and symptoms.4
See Article by Qintar et al
The traditional and unfortunately somewhat entrenched cultural reluctance of the PCI community to revascularize CTO is centered around a concern as to the Why?. We have accumulated a growing …