**Chronic Total Occlusion (CTO): Scientific Benefit and Principal Interventional Approach**

Michael Behnes and Kambis Mashayekhi

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.68303

#### **Abstract**

[221] Jones DA, Weerackody R, Rathod K, et al. Successful recanalization of chronic total occlusions is associated with improved long-term survival. J Am Coll Cardiol Intv

[222] Lee PH, Lee S-W, Park H-S, et al. Successful recanalization of native coronary chronic total occlusion is not associated with improved long-term survival. J Am Coll Cardiol

[223] Råmunddal T, Hoebers LP, Henriques JPS, et al. Prognostic impact of chronic total occlusions: a report from SCAAR (Swedish Coronary Angiography and Angioplasty

[224] Khan MF, Wendel CS, Thai HM, Movahed MR. Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheter

[225] Christakopoulos GE, Christopoulos G, Carlino M, et al. Meta-analysis of clinical outcomes of patients who underwent percutaneous coronary interventions for chronic

[226] White HD, Braunwald E. Applying the open artery theory: use of predictive survival

[227] Fujita S, Tamai H, Kyo E, et al. New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: the anchor technique.

[228] Lombardi WL. Retrograde PCI: what will they think of next? J Invas Cardiol 2009;21:543. [229] Dautov R, Ureña M, Nguyen CM, Gibrat C, Rinfret S. Safety and effectiveness of the surfing technique to cross septal collateral channels during retrograde chronic total occlusion percutaneous coronary intervention. EuroIntervention 2017;12:e1859-e1867.

[230] Vo MN, Ravandi A, Brilakis ES. "Tip-in" technique for retrograde chronic total occlu-

[231] Surmely J-F, Tsuchikane E, Katoh O, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invas

[232] Zhang B, Zhang B, Wong A, Wong A. The confluent balloon technique for retrograde therapy of chronic total occlusion. Catheter Cardiovasc Interv 2011;78:60-64.

[233] Carlino M, Azzalini L, Colombo A. A novel maneuver to facilitate retrograde wire externalization during retrograde chronic total occlusion percutaneous coronary inter-

Registry). J Am Coll Cardiol Intv 2016;9:1535-1544.

total occlusions. Am J Cardiol 2015;115:1367-1375.

markers. Eur Heart J 1998;19:1132-1139.

Catheter Cardiovasc Interv 2003;59:482-488.

Cardiol 2006;18:334-338.

sion revascularization. J Invas Cardiol 2015;27:E62-E64.

vention. Catheter Cardiovasc Interv 2017;89:E7-E12.

Cardiovasc Interv 2013;82:95-107.

2012;5:380-388.

84 Interventional Cardiology

Intv 2016;9:530-538.

Chronic total occlusion (CTO) of coronary arteries are found in about 20% of patients undergoing percutaneous coronary intervention (PCI) and in about 50% of post-CABG patients. Specialized centers can now achieve success rates of over 85%, which is a result of technical advancements in retrograde techniques irrespective of the CTO anatomy. Due to the complexity of retrograde CTO-techniques, a consensus paper issued by the EuroCTO-Club requires interventional cardiologists to have sufficient experience in antegrade approaches (>300 antegrade CTO-cases, 50/year) with additional retrograde training (25 retrograde cases each as first and second operator) before becoming an independent retrograde operator. The increased investment in time and technical resources may only be justified if the patient has a clear clinical benefit. However, technical advancements and the clearer evidence that complete revascularization can be achieved in patients with coronary multivessel disease have attracted growing interest in recent years from interventional cardiologists in treating CTO. The chapter will review current knowledge in the interventional treatment of CTO and focuses on indications and the potential benefits for the individual patient being based on the current state of scientific evidence.

**Keywords:** chronic total occlusion, CTO, percutaneous coronary intervention, PCI
