Chronic total coronary occlusion percutaneous intervention.

Chronic total coronary occlusions (CTO) are encountered frequently, found in up to 50% of patients with coronary artery disease (CAD) referred for elective angiography. Treatment strategy for an individual patient is often changed on the basis of the presence or absence of a CTO (1). Percutaneous coronary intervention (PCI) of CTO remains challenging, with observed success rates that are significantly lower than those for non-occluded lesions (2,3). Therefore, it is not surprising that in randomized trials from the BARI (Bypass Angioplasty Revascularization Investigation) trial to the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) study, CTO has endured as the strongest predictor for referral to coronary artery bypass surgery (CABG) rather than randomization.