State-of-the-Art Paper
Chronic Total Occlusion Angioplasty in the United States

https://doi.org/10.1016/j.jcin.2009.02.008Get rights and content
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Coronary chronic total occlusions (CTOs) are commonly encountered complex lesions identified in 15% of all patients referred for coronary angiography. Chronic total occlusion remains the most powerful predictor of referral for coronary bypass surgery. The benefits of CTO percutaneous coronary intervention (PCI) include symptom relief, improved left ventricular function, and potentially a survival advantage associated with success when compared with failed CTO-PCI. Data from the NCDR (National Cardiovascular Data Registry) suggest that CTO-PCI attempt rates in the U.S. have not changed over the past 5 years despite significant advances in techniques and technology, some of which we review here. Additionally, these data highlight a major disparity in attempt rates based on operator PCI volume. Remaining barriers to attempting CTO-PCI in the U.S. include operator inexperience, the perception of increased risk of CTO-PCI, and financial disincentives to operators and hospitals. To overcome operator inexperience, participation in CTO clubs, the invitation of guest operators, and a dedicated CTO day can be implemented at institutions committed to learning advanced CTO-PCI techniques so that operators can overcome the barriers and offer patients access to percutaneous therapy when it is clinically indicated.

Key Words

coronary artery disease
chronic total occlusion
angioplasty

Abbreviations and Acronyms

CART
controlled antegrade and retrograde tracking
CTO
chronic total occlusion
MI
myocardial infarction
NCDR
National Cardiovascular Data Registry
PCI
percutaneous coronary intervention

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Financial support provided by the family of Chad Simmons. Dr. Carlo Di Mario acted as Guest Editor for this paper.