Does successful chronic total occlusion recanalization fail to improve long-term survival?
There has been a significant increase in the number of patients undergoing successful CTO PCI in recent years, even though there might remains considerable controversy regarding the clinical benefit of this procedure. Although no randomized controlled clinical trials comparing CTO-PCI with medical therapy have been published to date, there is a growing body of evidence suggesting clinical benefits (1). These benefits include improvement of anginal symptoms, decreased anti-anginal medication intake, improved exercise capacity, improved left ventricular systolic function, decreased risk of arrhythmia, decreased the number of coronary artery bypass graft (CABG) procedures, and improved tolerance of future coronary occlusion events such as acute coronary syndrome among patients with successful versus failed CTO-PCI. Moreover, CTO is the most common reason for failing to achieve complete revascularization, and incomplete revascularization is associated with poorer clinical outcome compared with complete revascularization.