ABSTRACT
The typical atherosclerotic plaque of a chronic total occlusion (CTO) consists of intracellular and extracellular lipids, smooth muscle cells, extracellular matrix, and calcium. The implications of improving early procedural and long-term clinical outcomes with CTOs are considerable. Unfractionated heparin (UFH) is the preferred antithrombin therapy during percutaneous CTO revascularization. Recent evaluations with magnetic resonance imaging (MRI) in patients with CTOs provide further support toward improvement in left ventricular function, which may translate into favorable clinical outcomes for successful CTO revascularization. To identify which patients might benefit from revascularization, delayed-enhancement contrast MRI may be useful for the identification of viable and ischemic myocardium subtended by a CTO. Clinical experience has been useful in identifying viable myocardial tissue in spite of matched, regional wall motion abnormalities by other imaging methods. Collaterals preserve myocardial function and prevent cell death in the distribution of the occluded artery.
