Management of Coronary Chronic Total Occlusion

Pinak B. Shah, MD

Percutaneous coronary intervention (PCI) for coronary artery chronic total occlusion (CTO) is an important treatment to be used in conjunction with non-CTO PCI, coronary artery bypass grafting, and optimal medical therapy to achieve complete revascularization in patients with coronary artery disease.

A 67-year-old man with chronic stable angina presented with worsening angina to class III despite maximal medical therapy. He was referred for myocardial perfusion imaging, which showed a large area of inferior ischemia. Subsequent coronary angiography revealed a chronic total occlusion (CTO) of the right coronary artery with brisk collateral flow from the left anterior descending artery (Figure 1). There was minimal obstructive disease in the remainder of the coronary tree. An attempt at percutaneous coronary intervention (PCI) was unsuccessful. He was treated with continuation of his medical therapy, although he remained with lifestyle-limiting class II to III angina.

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