Contemporary issues of percutaneous coronary intervention in heavily calcified chronic total occlusions: an expert review from the European CTO Club

DOI: 10.4244/EIJ-D-22-01096

Kambis Mashayekhi
Kambis A. Mashayekhi1,2, MD, PhD; Stylianos A. Pyxaras3, MD, PhD; Gerald S. Werner4, MD, PhD; Alfredo R. Galassi5, MD, PhD; Roberto Garbo6, MD; Nicolas Boudou7, MD; Gregor Leibundgut8, MD, PhD; Alexandre Avran9, MD; Leszek Bryniarski10,11, MD, PhD; Alexander Bufe12, MD; Georgios Sianos13, MD, PhD; Carlo Di Mario14, MD, PhD
1. MediClin Heart Center Lahr, Lahr, Germany; 2. Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany; 3. Medizinische Klinik I, Klinikum Fürth, Fürth, Germany; 4. Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany; 5. U.O.C. Cardiologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (ProMISE) “G. D’Alessandro”, A.O.U. Policlinico Paolo Giaccone, Università degli Studi, Palermo, Italy; 6. Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy; 7. Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France; 8. Department of Cardiology, University Hospital Basel, Basel, Switzerland; 9. Department of Interventional Cardiology, Clinique Louis Pasteur, Essey-lès-Nancy, France; 10. Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; 11. Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; 12. Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany; 13. 1st Cardiology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece; 14. Structural Interventional Cardiology, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy

Severe calcification is frequent in coronary chronic total occlusions (CTO), and its presence has been associated with increased procedural complexity and poor long-term outcomes following percutaneous coronary intervention (PCI) in an already challenging anatomical setting. The diagnostic characterisation of heavily calcified CTOs using non-invasive and invasive imaging tools can lead to the application of different therapeutic options during CTO PCI, in order to achieve adequate lesion preparation and optimal stent implantation. In this expert review, the European Chronic Total Occlusion Club provides a contemporary, methodological approach, specifically addressing heavily calcified CTOs, suggesting an integration of evidence-based diagnostic methods to tailored, up-to-date percutaneous therapeutic options.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

calcified stenosischronic coronary total occlusionrotablator
Coronary interventionsCTO
Read next article
Diagnostic accuracy of optical flow ratio: an individual patient-data meta-analysis

Latest news