Chronic total occlusion percutaneous coronary interventions: identifying patients at risk of complications.

Angina refractory to medical therapy and providing complete revascularization (after acute coronary syndrome or in patients with ischemic cardiomyopathy) are common indications for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Unfortunately, CTO PCI is associated with higher rates of complications when compared with non-CTO PCI. In this article, we review available studies on risk prediction in CTO PCI and outline strategies to avoid complications. Identifying patients at increased risk of periprocedural major adverse cardiovascular events (MACE) is of great importance. It enhances the conversations about the risk and benefits of CTO PCI and it allows for shared decision making when deciding to undergo or forego such procedures.