Working Group Talk "Coronary physiology in the setting of chronic total occlusions"

Chronic total occlusions (CTOs) are present in 15–30% of patients undergoing coronary angiography. Patients with a CTO have higher mortality, higher occurrence of ventricular arrhythmias, and higher degree of angina or dyspnea. Moreover, CTOs are often found in the context of multi-vessel disease where the coronary physiology assessment might play a role in the selection of those patients requiring myocardial revascularisation. 

However, the presence of a CTO makes the coronary physiological assessment of non-CTO lesions more complex, especially if these lesions involve the vessels supplying the CTO territory through collaterals. Finally, what is the role of collateral vessels, of coronary microvascular resistances, of collateral steal phenomena, of the lesion severity in the donor artery as well as what changes may occur in the CTO territory after CTO PCI is still debated. 

Aims

This talk aims to provide an update on frequent questions such as:

• Why should a patient complain of new-onset symptoms caused by a CTO that has been present for months or even years? 
• How does a stenosis in the donor artery affect CTO blood supply? 
• What is the right timing for CTO PCI? 
• What is the optimal revascularisation strategy in patients with multi-vessel disease and CTOs? 
• What is the role of coronary physiological assessment before and after CTO PCI? 
• What outcomes can be expected following CTO PCI?

Programme

Chairs 

Raffaele Bugiardini, IT

Alfredo Ruggero Galassi, IT

Presentation

CTO-PCI and coronary physiology: a glimpse into the future

Omer Goktekin, TR

CTO-PCI: acute and long-term results

Alfredo Ruggero Galassi, IT

Resource