Chronic total occlusion percutaneous coronary intervention: the next chapter

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is evolving. Novel equipment has been introduced, and extensive training has been and continues to be performed throughout the world with encouraging results (Table 1).

In his issue of EuroIntervention, Vadalà et al describe 8,673 CTO PCIs performed by 89 expert operators in the European Registry of CTO (ERCTO) from 2021-20221. The technical success rate was 89.1%. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was 1.7% and was higher in retrograde cases. High-volume operators (HVOs, defined as having 300 documented entries in the registry and >50 CTO PCIs per year as first operator) had a higher success rate (especially for retrograde cases) and a lower number of MACCE than mid-volume operators (MVOs; mean annual volume of 27 cases).

The authors should be congratulated for increasing our understanding of contemporary CTO PCI. Improvements are needed in 4 areas: (a) safety, (b) success, (c) efficiency, and (d) availability.

Table 1. Contemporary outcomes of CTO PCI.

StudiesYearsNTechnical successMACCEPerforationsTamponadeDeathExperienced centre registries Euro CTO2021-20228,67389.1%1.7%3.8%0.4%0.3%PROGRESS CTO 2012-202211,68486.4%2.0%4.8%0.9%0.4%Japanese CTO PCI expert registry2014-20152,84689.9%2.0%0.4%0.2%PROGRESS MENATA 2018-20221,06391.0%1.6%4.6%0.5%OPEN-CTO2014-20151,05486.0%7.0%8.8%0.9%LATAM CTO 2008-20201,0482.5%3.1%0.9%1.0%RECHARGE 2014-20151,25386.0%2.6%1.3%0.2%Population-based registriesBCIS 2006-201428,0567.0%0.7%0.2%NCDR2009-201322,36558.5%1.6%0.3%0.4%BMC2 2010-20177,38953.4%3.3%0.5%1.4%CTO: chronic total...