Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting?

Coronary artery chronic total occlusions (CTOs) are an exacerbation of stable coronary artery disease (CAD) with advanced calcification. CTOs are defined as 100% coronary occlusions with Thrombolysis in Myocardial Infarction grade 0 flow persisting for >3 months. National database registries and large single-center series suggest that in patients with CAD the overall incidence of CTOs may vary from 16% to 19% in Japan and 29% to 33% in North America, making this a common problem globally. Treatment of CTOs should be considered if associated with symptoms or viable/ischemic myocardial territories. Historically, treatments have been via coronary artery bypass grafting (CABG) or medical therapy.