CTO Club: Revisiting the final frontier in PCI

摘要

When Andres Gruentzig (Fig. 1) took the first step to perform balloon angioplasty in 1977 in Zurich, Switzerland, we saw the beginning of a new era. Angioplasty first began as a therapy for single-vessel proximal stenosis, and in the early 1980s, with improvement in equipment and a few brave pioneers, this treatment went to the next level. Geoffrey Hartzler (Fig. 2), one of those early pioneers in angioplasty, advanced the therapy from very isolated patient subsets to the treatment of multivessel coronary disease. He also showed us the way to treat acute myocardial infarction, as well as patients with chronic total occlusions. His work showed that chronic total occlusion in percutaneous coronary intervention (PCI) even with rudimentary equipment could be approached effectively, and his group showed that there appeared to be a difference in outcome in chronic total occlusion (CTO) patients who were successfully or unsuccessfully treated. Dr. Hartzler also came up with the concept to approach CTOs in a retrograde fashion, in this case going across saphenous vein grafts, to advance into the native coronaries.