Myocardial perfusion imaging to guide percutaneous revascularization of chronic total occlusions: A gate keeper to the final frontier in PCI

摘要

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is experiencing a renaissance due to novel equipment and techniques resulting in enhanced safety and rising success rates from 50% to the range of 80%-90%. This progress has challenged the prevailing therapeutic dogma of treating CTOs predominantly with either stand alone medical therapy or coronary bypass surgery (CABG) when there is sufficient global disease burden. In fact, in an era of appropriate use criteria the presence of a CTO can be significant determinant for referral for CABG. However, with lesion-specific physiologic assessment, a significant portion of non-CTO lesions in multi-vessel disease patients with CTOs are found to be non-hemo-dynamically significant, reducing the territories requiring revascularization and thus expanding percutaneous therapeutic options.