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 total occlusions (CTOs) remains one of the major challenges in interventional cardiology.1,2 A CTO is a frequent condition encountered in catheterization laboratory and its prevalence in patients undergoing coronary angiography was reported to range from 12 to 20%.3,4 Although several observational studies have shown that successful PCI was associated with an improvement of symptoms and quality of life, a reduction in the need for coronary artery bypass grafting (CABG) surgery and an increase in long-term survival,5 – 8 only a minority of CTO patients are treated percutaneously.9 This might be explained by several reasons: the complexity of CTO procedures, which seek for specific equipments and dedicated operators in order to achieve a similar rate of success than non-CTO lesions; the fact that CTO PCIs are time-consuming procedures associated with elevated radiation exposure, increased amount of contrast load and higher risk of procedural complications; and the lack of prospective outcome data in respect to the adopted management strategy 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 treatment strategy.