A clinical rationale and strategy for chronic total coronary occlusion revascularization: innovative solutions to an old problem

CTO Histopathology CTOs most often arise from thrombotic occlusion followed by thrombus organization and tissue aging (10,11). Particularly relevant to PCI strategies for CTO recanalization is the histological finding that approximately half of all CTOs are <99% stenotic when observed by histopathology, despite the angiographic appearance of total occlusion with TIMI grade 0 antegrade flow. Moreover, little to no relationship exists between the severity of the histopathological lumen stenosis and either plaque composition or lesion age.