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(Circulation. 2005;112:2530-2537.)
© 2005 American Heart Association, Inc.

New Drugs and Technologies

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

A Consensus Document: Part II

Gregg W. Stone, MD; Nicolaus J. Reifart, MD; Issam Moussa, MD; Angela Hoye, MD; David A. Cox, MD; Antonio Colombo, MD; Donald S. Baim, MD; Paul S. Teirstein, MD; Bradley H. Strauss, MD, PhD; Matthew Selmon, MD; Gary S. Mintz, MD; Osamu Katoh, MD; Kazuaki Mitsudo, MD; Takahiko Suzuki, MD; Hideo Tamai, MD; Eberhard Grube, MD; Louis A. Cannon, MD; David E. Kandzari, MD; Mark Reisman, MD; Robert S. Schwartz, MD; Steven Bailey, MD; George Dangas, MD, PhD; Roxana Mehran, MD; Alexander Abizaid, MD; Jeffrey W. Moses, MD; Martin B. Leon, MD; Patrick W. Serruys, MD, PhD

From the Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S., I.M., G.S.M., G.D., R.M., J.W.M., M.B.L.); Kardiologisches Institut, Bad Soden, Germany (N.J.R.); Thoraxcenter, Rotterdam, the Netherlands (A.H., P.W.S.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Columbus Hospital, Milan, Italy (A.C.); Brigham and Women’s Hospital, Boston, Mass (D.S.B.); Scripps Clinic, La Jolla, Calif (P.S.T.); St Michael’s Hospital, Toronto, Ontario, Canada (B.H.S.); Cardiovascular Medicine and Coronary Intervention, Redwood City, Calif (M.S.); Toyohashi Heart Center, Toyohashi, Aichi, Japan (O.K., T.S.); Kurashiki Central Hospital, Okayama, Japan (K.M.); Shiga Medical Center for Adults, Moriyama, Japan (H.T.); Heart Center Siegburg, Siegburg, Germany (E.G.); Cardiac and Vascular Research Center of Northern Michigan, Petoskey (L.A.C.); Duke University Medical Center, Durham, NC (D.E.K.); Swedish Medical Center, Seattle, Wash (M.R.); Minneapolis Heart Institute Foundation, Minneapolis (R.S.S.); University of Texas Health Science Center at San Antonio (S.B.); and Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil (A.A.).

Correspondence to Gregg W. Stone, MD, Columbia University Medical Center, The Cardiovascular Research Foundation, 111 E 59th St, 11th Floor, New York, NY 10022. E-mail gs2184@columbia.edu

Key Words: coronary disease • occlusion • prognosis • revascularization

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In Part I of this article, the definitions, prevalence, and clinical presentation of chronic total occlusions (CTOs) were reviewed, the histopathology of CTOs was examined, efforts to replicate human CTOs with experimental models were appraised, and the clinical relevance and rationale for CTO revascularization were evaluated.¹ In Part II, we summarize the technical approach to and outcomes after percutaneous coronary intervention (PCI) of occluded coronary arteries, describe the novel devices and drugs approved and undergoing investigation for CTO recanalization, and conclude with practical perspectives on managing the patient with 1 or more chronic coronary occlusions.

	Outcomes After PCI of CTOs

 
Patient Selection and Revascularization Strategies
PCI of CTOs constitutes as many as 20% of all angioplasty procedures at selected centers,² although a rate of &10% is more typical,^3–6 suggesting that CTO angioplasty is attempted in 50 000 to 100 000 patients per year in the United States. Many more CTOs are present for which PCI is never attempted, representing one of the most common causes for referral to bypass surgery rather than PCI.^6–8 Furthermore, a large proportion of patients with CTOs are managed medically, the prognosis of whom may vary depending on the extent of viable myocardium and ischemia, concomitant atherosclerosis in other coronary and noncoronary vascular territories, and other comorbid conditions. The decision to attempt PCI of a CTO (versus continued medical therapy or surgical revascularization) requires an individualized risk/benefit analysis, encompassing clinical, angiographic, and technical considerations. Clinically, the patient’s age, symptom severity, associated comorbidities (eg, diabetes mellitus and chronic renal insufficiency), and overall functional status are major determinants . . . [Full Text of this Article]

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