Who Should Undergo Chronic Total Occlusion Percutaneous Coronary Intervention?: The EXPLORation Continues

Given greater patient, lesion, and technical complexity, CTO PCI carries higher risk as compared with non-CTO PCI (4,14), including potentially life-threatening complications, such as donor vessel thrombosis and perforation. [...]CTO PCI may require prolonged fluoroscopy time and contrast medium administration, although with use of newer x-ray systems, contrast medium volume rather than radiation dose is becoming the more common limiting factor for CTO PCI success. Two randomized controlled clinical trials comparing CTO PCI with medical therapy are currently under way: the DECISION-CTO (Drug-Eluting Stent Implantation Versus Optimal Medical Treatment in Patients With Chronic Total Occlusion; NCT01078051) trial and the EURO-CTO (European Study on the Utilization of Revascularization Versus Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions; NCT01760083) trial. [...]the SHINE CTO (Sham-Controlled Intervention to Improve Quality of Life in CTOs; NCT02784418) trial is randomizing patients to CTO PCI or a sham procedure to determine whether CTO PCI improves patients' symptoms.