Current challenges and prevention strategies for chronic total occlusion (CTO) complications

ABSTRACT

Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) can be challenging, but high success rates (85–90%) are currently achieved at experienced centers with approximately 3% risk for a major periprocedural complication.

Areas covered: CTO PCI complications can be categorized according to location such as cardiac and non-cardiac (vascular access complications, thromboembolic complications, contrast-related and radiation injury) complications. Cardiac complications are further subdivided into coronary (acute closure, perforation, and equipment loss or entrapment) and non-coronary (hypotension, myocardial infarction, tamponade, arrhythmias).

Expert opinion: In this article, we review strategies to prevent and treat CTO PCI complications. Careful monitoring throughout the case enables prevention and early detection of a complication. If a complication occurs, rapid implementation of treatment using an algorithmic approach can minimize its adverse impact.

KEYWORDS:

• Complication
• percutaneous coronary intervention
• chronic total occlusion
• management

Article highlights

• Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has approximately 3% risk for a major periprocedural complication at experienced centers.

• CTO PCI complications are categorized according to location: cardiac and non-cardiac complications; cardiac complications are subdivided into coronary and non-coronary complications.

• Careful monitoring throughout the case enables prevention and early detection of a complication.

• Rapid implementation of treatment using an algorithmic approach can minimize the adverse impact of complications.

Declaration of interest

E Brilakis has received consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens; owner, Hippocrates LLC; shareholder: MHI Ventures. N Rafeh is a proctor and consultant for BSC, Abbott and shockwave medical. A ElGuindy received consultancy and proctorship fees from Medtronic, Asahi Intecc, Boston Scientific, and Terumo. L Azzalini received consultant fees from Teleflex and 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

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.