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Purpose of Review <p>To review the evolution of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), including advances in device technology, crossing strategies, and contemporary evidence evaluating the clinical benefits of CTO PCI.</p> Recent Findings <p>Over the past four decades, CTO PCI has incrementally improved with success rates approaching 90% at dedicated centers. Advances in device technology have enabled the development of contemporary crossing strategies such as antegrade dissection and reentry and reverse controlled antegrade-retrograde tracking. Randomized trials consistently demonstrate improvements in angina, functional status, and quality of life after CTO PCI, while evidence for reduction in major adverse cardiac events remains neutral.</p> Summary <p>CTO PCI is best viewed as a symptom-driven intervention in selected patients. Procedural success depends largely on operator expertise. Future research should refine patient selection and clarify the role of CTO PCI in patients with ventricular dysfunction and other high-risk clinical subsets.</p>

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Chronic Total Occlusion Percutaneous Coronary Interventions: Evolution and Use of Crossing Strategies

  • 期刊论文

  • 发表日期：

    2026年6月23日

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  • Hassan Saleh,
  • Jaikirshan Khatri

摘要

Purpose of Review

To review the evolution of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), including advances in device technology, crossing strategies, and contemporary evidence evaluating the clinical benefits of CTO PCI.

Recent Findings

Over the past four decades, CTO PCI has incrementally improved with success rates approaching 90% at dedicated centers. Advances in device technology have enabled the development of contemporary crossing strategies such as antegrade dissection and reentry and reverse controlled antegrade-retrograde tracking. Randomized trials consistently demonstrate improvements in angina, functional status, and quality of life after CTO PCI, while evidence for reduction in major adverse cardiac events remains neutral.

Summary

CTO PCI is best viewed as a symptom-driven intervention in selected patients. Procedural success depends largely on operator expertise. Future research should refine patient selection and clarify the role of CTO PCI in patients with ventricular dysfunction and other high-risk clinical subsets.