Chronic total occlusion: To treat or not to treat

Table 2 Specific recommendations on the treatment of chronic total occlusion in the American and European Practice Guidelines

Society	Guideline	Specific recommendation on the treatment of CTO
EUROPEAN	2010 Guidelines of myocardial revascularization[9]	“Revascularization of CTO may be considered in the presence of angina or ischemia related to the corresponding territory”
	2013 ESC guidelines on the management of stable coronary artery disease[1]	“Revascularization needs to be discussed in patients with symptoms of occlusion or large ischemic areas”
AMERICAN	2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery[10]	Not mentioned
	2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention[11]	Recommendation IIa. Evidence level B. PCI of a CTO in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate expertise “The decision to try PCI for a CTO (vs continued medical therapy or surgical revascularization) requires an individualized risk-benefit analysis encompassing clinical, angiographic, and technical considerations”
	2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease[12]	Not mentioned

CTO: Chronic total occlusion; ACCF: American College of Cardiology Foundation; AHA: American Heart Association; SCAI: Society for Cardiovascular Angiography and Interventions; ACP: American College of Physicians; AATS: American Association for Thoracic Surgery; PCNA: Preventive Cardiovascular Nurses Association; STS: Society of Thoracic Surgeons; PCI: Percutaneous Coronary Intervention.