ABSTRACT
Chronic total occlusion (CTO) of a coronary artery is one of the last frontiers of percutaneous coronary intervention (PCI), because its immediate success rate and long-term results are much less favorable than PCI for other indications. The most common cause of procedural failure of CTO-PCI is the inability to cross the occlusion with a guidewire1,2. The guidewire might not have the mechanical strength to cross the occlusion or the guidewire might perforate the artery, thus dissecting the intima and creating a false lumen with possible blood extravasation and pericardial tamponade. The most frequent cause of poor long-term outcome is the development of restenosis and even reocclusion. This chapter reviews the usefulness of intravascular imaging for the improvement of both immediate and long-term outcome of recanalization of CTOs.
