ABSTRACT
A considerable variety of unsettled issues surround the field of chronic total occlusions (CTOs) as a target for revascularization procedures. The interventional cardiologist must weigh the individual risks and benefits for each patient when deciding to attempt percutaneous coronary intervention (PCI) of a CTO vs two other alternatives: aortocoronary bypass surgery or medical therapy. Angiographically, the extent and complexity of coronary artery disease, likelihood for complete revascularization, and the presence and degree of valvular heart disease and left ventricular dysfunction are all very important factors. Multiple CTOs with low probability of success or high probability of complication should be treated surgically. An individualized case selection is of paramount importance for PCI of a CTO. As a general rule, operators should begin with straightforward cases and progressively advance to more complex cases as they gain competency. Wires designed for treating CTOs can be divided into two groups: polymer-coated guidewires and non-coated coil guidewires; both groups also possess tapered and non-tapered tips.
