ABSTRACT
Often referred to as the 'final frontier' in coronary intervention, chronic total occlusions (CTOs) are amongst the most challenging lesions treated by interventional cardiologists' percutaneous coronary intervention (PCI) of these complex lesions, until recently, had been considered at relatively high risk of complications, of uncertain clinical benefit and with uncertain success rates. Coronary CTOs are generally defined as the total obstruction of coronary blood flow for at least 3 months. Ultimately, the indications and rationale for CTO PCI are similar to those for non-CTO PCI: reduction in symptoms with improvement in quality of life, a reduction in ischaemia and possibly, a decrease in mortality and myocardial infarction. Multiple observational studies have indicated increased cardiac risk with large ischaemic burden. Perhaps the most important benefit of CTO PCI is an improvement in quality of life. Fundamentally, CTO PCI is a procedure that requires infrastructural and human resource input in excess of standard PCI in order to achieve success.
