Chronic total occlusion percutaneous coronary intervention scores: present and future

It is 2050. A patient presents with exertional angina and a right coronary artery chronic total occlusion (CTO). Preprocedural modelling reveals a 39% increase in exercise capacity and 95% complete symptom resolution upon recanalisation. Multimodality scanning shows a clear proximal cap, a length of 35.4 mm with 56% eccentric medial calcification, a negatively remodelled distal vessel with a mean diameter of 2.45 mm, with potential for expansion by 0.32 mm post recanalisation and collateral circulation by septals with three potentially appropriate channels for retrograde crossing with an 88.9% likelihood of successful guidewire and 88.5% likelihood of microcatheter crossing. Upon three-dimensional mapping of the optimal crossing routes, the self-propelled ...