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World J Cardiol. Jul 26, 2014; 6(7): 621-629
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.621
Chronic total occlusion: To treat or not to treat
Alfredo Bardají, Judit Rodriguez-López, Mauricio Torres-Sánchez
Alfredo Bardají, Judit Rodriguez-López, Mauricio Torres-Sánchez, Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira Virgili, 3007 Tarragona, España
Author contributions: Bardají A, Rodriguez-López J and Torres-Sánchez M performed research; Bardají A wrote the paper.
Correspondence to: Alfredo Bardají, MD, PhD, FESC, Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira Virgili, Calle Dr Mallafré Guasch 4, 43007 Tarragona, España. alfredo.bardaji@urv.cat
Telephone: +34-97-7295834 Fax: +34-97-7295859
Received: December 23, 2013
Revised: January 20, 2014
Accepted: May 16, 2014
Published online: July 26, 2014
Abstract

Over the last two decades, there has been increasing interest in new techniques for the percutaneous treatment of coronary chronic total occlusions (CTO), which have a success rate that is much higher than that of a few years ago. The rise in percutaneous treatment for these lesions is due to its ability to improve the symptoms and prognosis of patients in the chronic and stable phase of coronary disease. Current data suggest that successful percutaneous coronary intervention for CTO is associated with improvement in patient symptoms, quality of life, left ventricular function, and survival, compared with those with unsuccessful CTO PCI. However, all the scientific evidence supporting this treatment comes from observational studies, and no randomized study comparing percutaneous treatment with medical treatment has yet been published. A major limitation of these studies is their observational design, with limited information with regard to potential baseline differences between the successful vs unsuccessful cohorts. Pending randomized studies, patients should be selected very carefully, especially if they are asymptomatic or very few symptoms, and the benefits obtained in terms of complications during the procedure, the quality of life obtained and further ischemic events avoided should be evaluated systematically. In this review, we will consider the available information supporting percutaneous treatment for chronic occlusions, as well as the areas of uncertainty where more research projects are required.

Keywords: Chronic total occlusion, Percutaneous coronary intervention

Core tip: This is a critical review about the available information supporting percutaneous treatment for chronic occlusions, as well as the areas of uncertainty where more research projects are required.