An overview of chronic total occlusion percutaneous coronary intervention complications

Complications of CTO PCI can be classified according to timing (as acute and long-term) and according to location (cardiac coronary, cardiac noncoronary, and noncardiac). Another potential classification is by complication severity. Perforation is the most feared complication of CTO PCI and can occur with both antegrade and retrograde crossing attempts. The retrograde approach carries higher risk of complications, but is also more often required in more complex occlusions. The risk of complications can be minimized by awareness of what can go wrong during each step of the procedure and by continuous systematic patient monitoring. If a complication occurs, effective and prompt corrective action can improve outcomes and depends on having algorithms and systems of care in place. Having easy and rapid access to necessary equipment (covered stents, coils, snares) can be facilitated through use of a dedicated CTO or complex PCI cart.