PMID- 28315181
OWN - NLM
STAT- MEDLINE
DCOM- 20171012
LR  - 20181202
IS  - 1534-6242 (Electronic)
IS  - 1523-3804 (Linking)
VI  - 19
IP  - 4
DP  - 2017 Apr
TI  - Update on the Management of Chronic Total Occlusions in Coronary Artery Disease.
PG  - 19
LID - 10.1007/s11883-017-0655-0 [doi]
AB  - PURPOSE OF THE REVIEW: Chronic total occlusions (CTOs) are found in about a third 
      of patients with coronary artery disease (CAD) and can pose a significant 
      challenge during percutaneous revascularization. However, advances in CTO 
      percutaneous coronary intervention (PCI) strategies, devices, and algorithms have 
      led to significant improvements in successful treatment of CTOs. This review 
      summarizes current management of CTOs in the context of modern PCI techniques and 
      current evidence. RECENT FINDINGS: The hybrid algorithm now provides a 
      standardized, teachable approach to CTO PCI, and success rates are approximately 
      90% in experienced hands. The first randomized controlled trial in patients with 
      CTOs recently reported that patients with ST elevation myocardial infarction 
      (STEMI) and a CTO in the non-culprit vessel showed an improvement in ejection 
      fraction in patients undergoing CTO PCI of the LAD, but not other vessels. 
      Updated data from the SYNTAX trial showed a benefit with complete 
      revascularization in patients with coronary artery disease (CAD). Incomplete 
      revascularization of CTOs in the PCI group may explain some of the benefit seen 
      with CABG over PCI in patients with complex coronary disease. Contemporary CTO 
      registries have reported success rates of approximately 90%, and the OPEN-CTO 
      registry updates our understanding of CTO PCI complication rates and outcomes. 
      The available evidence highlights the potential benefits of CTO PCI in patients 
      with an indication for revascularization. Technological advancements have paved 
      the way for success rates approaching 90% at high-volume centers, but further 
      studies evaluating outcomes following CTO PCI are needed, with several currently 
      underway.
FAU - Kearney, Kathleen
AU  - Kearney K
AD  - Division of Cardiology, University of Washington, Seattle, WA, USA. 
      KaKearney@cardiology.washington.edu.
FAU - Hira, Ravi S
AU  - Hira RS
AD  - Division of Cardiology, University of Washington, Seattle, WA, USA.
FAU - Riley, Robert F
AU  - Riley RF
AD  - Division of Cardiology, University of Washington, Seattle, WA, USA.
FAU - Kalyanasundaram, Arun
AU  - Kalyanasundaram A
AD  - Division of Cardiology, Swedish Medical Center, Seattle, WA, USA.
FAU - Lombardi, William L
AU  - Lombardi WL
AD  - Division of Cardiology, University of Washington, Seattle, WA, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Atheroscler Rep
JT  - Current atherosclerosis reports
JID - 100897685
SB  - IM
MH  - Coronary Artery Disease/*therapy
MH  - Coronary Occlusion/*therapy
MH  - Humans
MH  - Percutaneous Coronary Intervention
MH  - Treatment Outcome
OTO - NOTNLM
OT  - CAD (coronary artery disease)
OT  - CTO (chronic total occlusion)
OT  - Complete revascularization
EDAT- 2017/03/21 06:00
MHDA- 2017/10/13 06:00
CRDT- 2017/03/19 06:00
PHST- 2017/03/19 06:00 [entrez]
PHST- 2017/03/21 06:00 [pubmed]
PHST- 2017/10/13 06:00 [medline]
AID - 10.1007/s11883-017-0655-0 [pii]
AID - 10.1007/s11883-017-0655-0 [doi]
PST - ppublish
SO  - Curr Atheroscler Rep. 2017 Apr;19(4):19. doi: 10.1007/s11883-017-0655-0.