Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions

Percutaneous coronary intervention (PCI) for coronary chronic totalocclusions (CTOs) remains one of the major challenges in interventionalcardiology.1,2 A CTO is a frequent condition encounteredin catheterization laboratory and its prevalence in patients undergoingcoronary angiography was reported to range from 12 to 20%.3,4Although several observational studies have shown that successfulPCI was associated with an improvement of symptoms and qualityof life, a reduction in the need for coronary artery bypass grafting(CABG) surgery and an increase in long-term survival,5 – 8 only a minorityof CTO patients are treated percutaneously.9 This might beexplained by several reasons: the complexity of CTO procedures,which seek for specific equipments and dedicated operators in orderto achieve a similar rate of success than non-CTO lesions; thefact that CTO PCIs are time-consuming procedures associatedwith elevated radiation exposure, increased amount of contrastload and higher risk of procedural complications; and the lack ofprospective outcome data in respect to the adopted managementstrategy for CTO lesion [optimal medical therapy (MT), CABG,or PCI).The aim of the Italian Registry of Chronic Total Occlusions(IRCTO) was to provide detailed data on prevalence, characteristics,and outcome of CTO patients according to the adopted treatmentstrategy.