Complications of chronic total occlusion percutaneous coronary intervention

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is technically challenging. CTOs are common in patients referred for coronary angiography. CTO PCI is typically reserved for patients with refractory angina who have failed medical therapy. Successful recanalization of CTOs approaches >80%. Techniques and devices continue to optimize percutaneous treatment of CTOs. Major complications are rare in CTO PCI. However, a distinctive set of cardiac (e.g., coronary perforation, dissection and cardiac tamponade) and extracardiac (e.g., radiation injury) complications are associated with CTO PCI. CTO operators should be aware of the available strategies for prevention and management of CTO PCI-related complications.