Current challenges and prevention strategies for chronic total occlusion (CTO) complications

Expert Rev Cardiovasc Ther. 2021 Apr;19(4):337-347. doi: 10.1080/14779072.2021.1905521. Epub 2021 Apr 23.

Abstract

Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) can be challenging, but high success rates (85-90%) are currently achieved at experienced centers with approximately 3% risk for a major periprocedural complication.Areas covered: CTO PCI complications can be categorized according to location such as cardiac and non-cardiac (vascular access complications, thromboembolic complications, contrast-related and radiation injury) complications. Cardiac complications are further subdivided into coronary (acute closure, perforation, and equipment loss or entrapment) and non-coronary (hypotension, myocardial infarction, tamponade, arrhythmias).Expert opinion: In this article, we review strategies to prevent and treat CTO PCI complications. Careful monitoring throughout the case enables prevention and early detection of a complication. If a complication occurs, rapid implementation of treatment using an algorithmic approach can minimize its adverse impact.

Keywords: Complication; chronic total occlusion; management; percutaneous coronary intervention.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Coronary Occlusion / therapy*
  • Heart Diseases / epidemiology
  • Humans
  • Myocardial Infarction / epidemiology
  • Percutaneous Coronary Intervention / methods*
  • Risk Factors
  • Treatment Outcome