Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention

Lorenzo Azzalini, Dimitri Karmpaliotis, Ricardo Santiago, Kambis Mashayekhi, Carlo Di Mario, Stéphane Rinfret, William J. Nicholson, Mauro Carlino, Masahisa Yamane, Etsuo Tsuchikane, Emmanouil S. Brilakis

Research output: Contribution to journalReview articlepeer-review

48 Scopus citations


Remarkable progress has been achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent years, with refinement of the indications and technical aspects of the procedure, imaging, and complication management. Randomized controlled trials and rigorous prospective registries have provided high-quality data on the benefits and risks of CTO PCI. Global collaboration has led to an agreement on nomenclature, indications, endpoint definition, and principles of clinical trial design that have been distilled in global consensus documents such as the CTO Academic Research Consortium. Increased use of preprocedural coronary computed tomography angiography and intraprocedural intravascular imaging, as well as development of novel techniques and structured CTO crossing and complication management algorithms, allow a systematic, stepwise approach to this difficult lesion subset. This state-of-the-art review provides a comprehensive discussion about the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO PCI.

Original languageEnglish (US)
Pages (from-to)1-21
Number of pages21
JournalJACC: Cardiovascular Interventions
Issue number1
StatePublished - Jan 10 2022
Externally publishedYes


  • CTO
  • coronary chronic total occlusion
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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