Emmanouil S. Brilakis, MD, PhD, FACC, FAHA, FESC, FSCAI

One might not think there are many similarities between hiking and chronic total occlusion PCI, but a recent family trip led me to think there are many lessons about hiking that can also apply to CTO PCI.

Chronic total occlusion PCI continues to rapidly evolve. One of the best ways to keep up — or go ahead — with new techniques, equipment and innovation is to attend a meeting.

The key concept is that time is finite, hence using it in the best possible way can lead to the best outcomes. Chronic total occlusion intervention can be challenging to perform and may take a long time.

It was 9 p.m. when the case ended. It was a 3-hour chronic total occlusion attempt that failed, fortunately without any complications.

The development of the hybrid algorithm to guide crossing of coronary chronic total occlusions was a pivotal event in chronic total occlusion PCI.

New data from the DECISION-CTO trial, presented at the American College of Cardiology Scientific Session in March, have fueled the ongoing controversy about the risks and benefits of chronic total occlusion PCI.

It is wonderful when a chronic total occlusion is crossed within minutes after starting crossing attempts. However, more often than not, chronic total occlusions can be challenging to cross and initial attempts may fail.

Chronic total occlusion PCI is a symphony. However, unlike music symphony, CTO PCI does not follow a prewritten script.

This CTO Corner summarizes findings of two trials of interest: EXPLORE and OPEN CTO.

Chronic total occlusion PCI has grown during recent years in the United States for multiple reasons.