LAUSR

Chronic total occlusions (CTO) are coronary occlusions with no anterograde flow through the lesion with a presumed (probable CTO) or documented (definite CTO) duration of ≥3 months. CTO's are commonly found at coronary angiography, despite this there is a paucity of randomized evidence in the field which can make decision making with regard to undertaking CTO‐percutaneous coronary intervention (PCI) more challenging, particularly as CTO‐PCI has a lower success rate and increased complication rate when compared to PCI in non‐occlusive lesions. Over the past two decades there have been significant advances in techniques, training and procedural outcomes leading to improved technical and procedural success in CTO‐PCI. At present the main indication and benefit of CTO‐PCI is improvement in symptoms of angina or anginal equivalent and improved quality of life. In experienced centers CTO‐PCI has a success rate of 85%–90% with a risk of major complications of approximately 3%. Therefore, a careful individualized risk benefit analysis should be carried out when offering CTO‐PCI, as to realize the benefit of CTO‐PCI the vessel must be successfully recanalized.