Article Text

Download PDFPDF
Chronic total occlusion percutaneous coronary intervention in clinical practice: novel grounds to be EXPLOREd
  1. Sinisa Stojkovic1,2,
  2. Dejan Milasinovic1
  1. 1 Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
  2. 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  1. Correspondence to Professor Sinisa Stojkovic, Department of Cardiology, Clinical Center of Serbia, Belgrade 11000, Serbia; sstojkovi{at}mts.rs

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Although chronic total occlusions (CTOs) are a common coronary angiographic finding, with an incidence reaching >25%, a disproportionately smaller portion of patients are treated with percutaneous coronary intervention (PCI), comprising 8% of the overall PCI volume.1 There appear to be at least two important issues that are associated with the existing discrepancy between the occurrence of CTO and the rate of CTO PCI in contemporary clinical practice. First, percutaneous CTO recanalisation is often considered to be technically difficult, resource-demanding and time-demanding, with a complication rate exceeding that of a non-CTO PCI. However, recent advances in the interventional technique, both antegrade and retrograde, including the hybrid algorithm, have resulted in >90% procedural success rates, while being associated with a low occurrence of major complications, such as cardiac tamponade, myocardial infarction and death (all well below 1%).1 Second, the evidence base regarding clinical benefits of CTO PCI over medical therapy has largely been confined to observational data, stemming mainly from retrospective comparisons of clinical outcomes in patients with successful versus failed CTO PCI,1 whereas randomised studies evaluating the effects of PCI versus medical therapy for CTO have been scarce. Notwithstanding the currently insufficient randomised evidence base, the clinical appeal of CTO PCI seems to, at least in part, rest on the notion of achieving percutaneous complete revascularisation in patients with significant coronary artery disease as incomplete revascularisation has been linked to impaired prognosis.2

In their Heart manuscript, Elias et al 3 present long-term data of the hitherto only randomised controlled trial evaluating the effects of CTO PCI versus conservative management, published in a peer-review journal. Moreover, this was the first study to randomly investigate the value of PCI for a non-culprit CTO, …

View Full Text

Footnotes

  • i Results presented at EuroPCR 2017, not published in a peer-review journal.

  • Contributors Both authors wrote and reviewed the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

  • Coronary artery disease
    Joëlle Elias Ivo M van Dongen Truls Råmunddal Peep Laanmets Erlend Eriksen Martijn Meuwissen H Rolf Michels Matthijs Bax Dan Ioanes Maarten Jan Suttorp Bradley H Strauss Emanuele Barbato Koen M Marques Bimmer E P M Claessen Alexander Hirsch René J van der Schaaf Jan G P Tijssen José P S Henriques Loes P Hoebers on behalf of the EXPLORE investigators JPS Henriques JJ Piek RJ De Winter KT Koch MM Vis J Baan JJ Wykrzykowska EM Scheunhage T Råmunddal D Ioanes EL Pommer P Laanmets M Tamm RJ Van Der schaaf T Slagboom G Amoroso V Stolk E Eriksen V Tuseth LM Moldestad M Bax CE Schotborgh C de Jonge MJ Suttorp M Bosschaert C Feirabend E Barbato H Batjoens B Strauss P Reilly KM Marques EJ Verduyn O Bertrand M Meuwissen M Baas M Van der Ent AF Haan J Koolen L Van Leur JPS Henriques RJ Van Der Schaaf JGP Tijssen LPC Hoebers J Elias IM Van Dongen M Meuwissen Hr Michels C Dille R Nijveldt R Kooistra JC Tuinenburg P Agostoni G Van Houwelingen