Muraca I, Carrabba N, Virgili G, Bruscoli F, Migliorini A, Pennesi M, Pontecorboli G, Marchionni N, Valenti R. Chronic total occlusion revascularization: A complex piece to "complete" the puzzle. World J Cardiol 2022; 14(1): 13-28 [PMID: 35126869 DOI: 10.4330/wjc.v14.i1.13]
Corresponding Author of This Article
Renato Valenti, MD, Chief Doctor, Cardiovascular Department, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy. renato.valenti2@tin.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Muraca I and Valenti R conceptualization and drafting of the manuscript; Migliorini A, Pennesi M and Pontecorboli G drafting of the manuscript; Virgili G and Bruscoli F creation of graphs, table and bibliographic research; Carrabba N and Marchionni N critical review of the manuscript. All authors approved the content of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Renato Valenti, MD, Chief Doctor, Cardiovascular Department, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy. renato.valenti2@tin.it
Received: March 17, 2021 Peer-review started: March 17, 2021 First decision: July 8, 2021 Revised: July 15, 2021 Accepted: December 31, 2021 Article in press: December 31, 2021 Published online: January 26, 2022 Processing time: 307 Days and 8.3 Hours
Abstract
Treatment of coronary chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has rapidly increased during the past decades. Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success. The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently, has led to an exponential increase in the number of CTO-PCI procedures, even if are still underutilized. It has been widely demonstrated that complete coronary revascularization, achieved by either coronary artery bypass graft or PCI, is associated with prognostic improvement, in terms of increased survival and reduction of major adverse cardiovascular events. The application of “contemporary” strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit, even in high-risk patients or complex coronary anatomy with CTO. The increasing success of CTO-PCI, allowing a complete or reasonable incomplete coronary revascularization, is enabling to overcome the last great challenge of interventional cardiology, adding a “complex” piece to “complete” the puzzle.
Core Tip: The application of “contemporary” revascularization strategy in coronary chronic total occlusion percutaneous interventions, allowed a high procedural success rate and to achieve a complete or reasonable incomplete coronary revascularization. From a procedural and clinical management point of view, an improved accuracy in clinical decision making process and a state-of-the-art revascularization, led to a long-term clinical benefit, even in high-risk patients or complex coronary anatomy.
