Percutaneous Coronary Interventions for Chronic Total Occlusions: More Benefit for the Patient or for the Interventionist's Ego?

Chronic total occlusions (CTOs) represent a common lesion subsetobserved in patients who undergo coronary angiography. During thepast decade, the interest of the interventionist community in CTOs hasexponentially grown with fast advancement in dedicated equipmentand techniques, which has resulted in high rates of procedural successand low rates of complications. Although different observationalstudies have shown that CTO revascularization was associated withgood clinical outcome, its real benefit for patients remains to bedetermined, particularly in the absence of randomized trials. In addition,compared with non-CTO lesions, the American and Europeanguidelines downgraded percutaneous coronary intervention in thesetting of CTOs. In this viewpoint, we try to identify patients who wouldbenefit from CTO recanalization, and discuss the issues that mightimprove the appropriateness of CTO percutaneous coronaryintervention.