Chronic total occlusion percutaneous coronary interventions: identifying patients at risk of complications

ABSTRACT

Introduction

Angina refractory to medical therapy and providing complete revascularization (after acute coronary syndrome or in patients with ischemic cardiomyopathy) are common indications for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Unfortunately, CTO PCI is associated with higher rates of complications when compared with non-CTO PCI.

Areas covered

In this article, we review available studies on risk prediction in CTO PCI and outline strategies to avoid complications.

Expert opinion

Identifying patients at increased risk of periprocedural major adverse cardiovascular events (MACE) is of great importance. It enhances the conversations about the risk and benefits of CTO PCI and it allows for shared decision making when deciding to undergo or forego such procedures.

KEYWORDS:

• Chronic total occlusion
• percutaneous Coronary Intervention
• high risk PCI
• PCI Complications
• major Adverse Cardiovascular Events

Article highlights

• CTO PCI is associated with higher rates of complications when compared with non-CTO PCI.

• There are various risk prediction models to identify patients at high risk of complication during CTO PCI.

• Identifying patients at increased risk of periprocedural major adverse cardiovascular events (MACE) is of great importance as it facilitates the conversations about the risk and benefits of CTO PCI and shared decision making.

• In addition, it allows operators time for procedural planning to mitigate these risks.

Declaration of interest

K Alaswad is a consultant for Abbott Vascular, Boston Scientific, Cardiovascular Systems Inc, and Teleflex. M Basir is a consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, Procyrion and Zoll. S Neupane is a consultant for Cardiovascular Systems Inc and serves as a speaker for Abiomed. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they receive educational support from Boston Scientific and Asahi Inc. They also receive research grants from Boston Scientific. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.