Complications during chronic total occlusion percutaneous coronary intervention: a sign- and symptom-based approach to early diagnosis and treatment

Coronary chronic total occlusions (CTO) are frequently found in patients undergoing coronary angiography. Despite their high prevalence and indication for revascularization in a relevant proportion of cases, CTO recanalization is attempted only in a minority of cases. This is due to higher risk of procedural complications compared to non-CTO interventions and because CTO-PCIs are the most complex procedures in interventional cardiology. In particular, the perceived higher risk of complications during CTO interventions might discourage new operators from engaging in this challenging field. The aim of this work was to review the potential complications of CTO percutaneous coronary intervention, and to provide an algorithmic, sign-and symptom-based approach to facilitate early recognition and effective management.