ABSTRACT
This chapter aims to review the rationale for treatment with drug-eluting stents (DESs) in chronic total occlusion (CTO) revascularization, summarizes DES clinical trial results, primarily from North America and describes future directions for investigation. In spite of the widespread use of the DES beyond approved patient and lesion indications, until recently, few investigations have been performed to support the clinical benefit of the DES in CTO revascularization. Several modest-sized observational studies examining clinical outcomes among patients treated with DES following successful CTO recanalization have supported the notion that, unlike bare metal stents, DES may achieve similar reductions in the need for repeat target vessel revascularization, as observed in non-occlusive lesions. Whether safety, clinical efficacy, and angiographic outcomes are similar between differing DESs have only been examined. Despite more predictable variance in measures of neointimal hyperplasia by angiography and intravascular ultrasound, demonstration of differences in clinical outcome has been less consistent.
