Percutaneous treatment of chronic total coronary occlusion

: Although frequent, chronic total occlusion (CTO) has long been neglected by interventional cardiologists, considering that the risk of complications was too high compared to the expected benefits. The presence of a CTO has therefore been an essential decision-making factor for referral of patients with multivessel disease to surgical coronary revascularization, or for the choice of the optimization of medical treatment in patients with an isolated CTO. The recent years technical progress of and the development of specific tools for percutaneous treatment of CTO have allowed to gradually change the vision within the cardiology community as the benefits in terms of quality of life and of complete revascularization have been clearly demonstrated. In contrast, the benefit on survival and improvement of left ventricular systolic function, although highlighted in meta-analyses and in some registries, has yet to be demonstrated by prospective randomized studies. The different reasons for considering percutaneous revascularization of CTO are discussed in this article. We will also review how to select patients based on clinical and angiographic data.