Chapter

Chronic total occlusions

Neville Kukreja, Pawel Tyczynski and Carlo di Mario

in Oxford Textbook of Interventional Cardiology

Published on behalf of Oxford University Press

ISBN: 9780199569083
Published online July 2011 | e-ISBN: 9780199697816 | DOI: http://dx.doi.org/10.1093/med/9780199569083.003.020

Series: Oxford Textbooks

Chronic total occlusions

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Chronic total occlusions (CTOs) remain the most technically challenging and time-consuming subset of coronary artery lesions to treat with percutaneous intervention (PCI). Particular difficulties may be encountered in crossing and dilating the lesion, whilst the rates of restenosis are higher than other lesions even after successful PCI. The presence of a CTO frequently prevents complete percutaneous revascularization, and may therefore provide justification for either revascularizing patients by means of coronary artery bypass grafting (CABG) or denying revascularization in favour of a more conservative approach. CTOs can cause severe disabling angina and lead to an impairment of regional and global left ventricular function. This explains why opening CTOs may provide a benefit exceeding the recognized ability of PCI to improve symptoms, and favourably impact upon long-term prognosis. This chapter aims to provide a comprehensive review of the literature on indications and results of CTO treatment as well as providing a modern practical technical guide to planning and executing CTO revascularization.

Chapter.  8452 words.  Illustrated.

Subjects: Radiology ; Cardiovascular Medicine

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