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The present article deals with the indications for revascularization of chronic total occlusions (CTO) of the coronary arteries. The introduction section briefly summarizes the history and development of CTO PCI. The main content of the paper is divided into three sections: the first one summarizes the current American and European societies of cardiology guidelines on CTO PCI; the second one provides a reflection on the most important aspects of the indication process from the most recent expert consensus; and the third one conveys the author’s personal experience with indicating patients for CTO recanalization. The paper also includes an overview of randomized trials on CTO PCI. [ABSTRACT FROM AUTHOR]

The case report presents two views on the concept of “triple combination” in treating a particular patient with coronary artery disease. The first, somewhat untraditional meaning of the two-word expression is used to describe an unusual case of three chronic total occlusions (CTO) in three different coronary territories clinically manifested by heart failure in the setting of ischaemic cardiomyopathy. All the occlusions were gradually recanalized using CTO PCI techniques with a good angiographic and clinical effect. There was a marked improvement in the original systolic left ventricular dysfunction. The individual procedures are illustrated by images and accompanied by general information on CTO PCI. A second meaning of the words “triple combination” – in a more traditional pharmacotherapeutic sense – represents a fixed combination of three antihypertensive and lipid-lowering drugs which were used in the same patient to optimize the secondary preventive therapeutic regimen. [ABSTRACT FROM AUTHOR]

PCI for chronic total occlusion (CTO) of coronary arteries is one of the most dynamically developing fields in interventional cardiology. The issue itself involves some controversy. These are very complex procedures which, on the one hand, can significantly improve the quality of life of many patients, but on the other hand, are burdened by a higher risk of periprocedural complications compared to common non-CTO PCI. The fact that, even in our conditions, dedicated CTO programmes with increasing numbers of these procedures were set up at some centres implies that it is a current issue. The review article presents an abridged version of a state-of-the-art document developed by world-renowned experts in the subject of CTO. The basic principles of a successful and safe CTO PCI programme are divided into seven general principles, ranging from indications to planning of procedures and their technical aspects to minimizing the risk of developing and/or possibly managing complications. [ABSTRACT FROM AUTHOR]

Aim: Percutaneous coronary intervention (PCI) for coronary artery chronic total occlusion (CTO) has been a rapidly evolving branch of interventional cardiology in recent years. The article presents our two-year experience with the development of a dedicated CTO programme, while focusing on stratification of CTO difficulty depending on the J-CTO scoring system and the role of the proctor in the learning curve. Material and methods: The study cohort comprised consecutive patients who underwent PCI for CTO at our centre during the period from 08/2016 to 10/2018. The following aspects were studied: the basic patient characteristics and technical aspects of the procedure; the estimated difficulty depending on the J-CTO score; the proportions of various recanalization techniques; whether or not a proctor was present during the procedure; and the rates of complications. Procedures with a J-CTO score ≥ 2 were graded as difficult in consistency with the authors of the scoring system. Results: The overall success rate of CTO PCI in the follow-up period was 84.4 %. The mean fluorocopic time per procedure was 30:17 minutes, the irradiation dose 2 660 mGy, and contrast medium consumption 262 ml. In successful procedures, the final strategy that resulted in CTO recanalization was antegrade wire escalation in 65.6 %, retrograde dissection-reentry technique in 11.1 %, and retrograde wire escalation in 6.7 %. In one case, we succeeded with antegrade dissection-reentry technique. While the success rate of CTO PCI for J-CTO scores of 0-1 reached 94.9%, in difficult cases (J-CTO ≥ 2) the success rate was only 76.5%. Proctored procedures versus unproctored ones had a higher mean J-CTO score (2.3 vs. 1.7), a higher proportion of difficult findings with a J-CTO ≥ 2 (66.7 % vs. 52.4 %), a higher percentage of retrograde procedures (55.6 % vs. 19.1 %), and a higher success rate was achieved with them (92.6 % vs. 81.0 %). Clinically severe complications occurred in 4.5%, and there was no periprocedural death or tamponade. Conclusion: The present cohort represents the first two years of the CTO PCI learning curve showing that, when certain rules are followed, it is possible to master the CTO PCI techniques and introduce them into normal operation of a catheterization room as an effective and safe treatment method for patients with a specific, and not rare, type of coronary disease. [ABSTRACT FROM AUTHOR]