Current Evidence Base for Chronic Total Occlusion Revascularization Retrograde Approach

A Practical Guide for Maximizing Procedural Success

Hannah Douglas; Nicola G Johnston; Alan J Bagnall; Simon J Walsh


Interv Cardiol. 2013;5(5):541-548. 

In This Article

Abstract and Introduction


Coronary chronic total occlusion (CTO) accounts for an increasing proportion of referrals for percutaneous revascularization. In contrast to acute myocardial infarction, the presence of collaterals and the slow progression of occlusion mandate different considerations when deciding upon revascularization strategies. The identification and referral of CTO lesions continues to grow as the technical success of percutaneous revascularization improves and the evidence base supporting their treatment matures. Preprocedural case examination and strategy planning are becoming routine in the management of CTOs. However, there remains controversy over the indications for recanalizing CTOs and, in particular, the further management of those patients with unsuccessful CTO revascularization attempts. This article will review the evidence for treating CTOs percutaneously.


Chronic total occlusion (CTO) is defined as when atherosclerotic coronary artery disease (CAD) produces the complete or almost complete obstruction of flow in an epicardial vessel for a period of 3 months or greater.[1,2] Successful revascularization of CTOs is associated with improvement in symptoms, quality of life and prognosis.[3] The safety and success of percutaneous treatment of CTO has increased in recent years, particularly with the advent of hybrid approaches combining antegrade, retrograde and limited subintimal methods.[4] Although no randomized controlled trial data directly comparing different treatment strategies are available, this review will summarize the available data supporting the use of CTO percutaneous coronary intervention (PCI) to improve patient outcomes.