Preprocedural Planning for Chronic Total Occlusion Percutaneous Coronary Intervention

Chronic total occlusions (CTO) are frequently encountered in clinical practice. Although the success rates and safety of CTO percutaneous coronary intervention (PCI) have significantly improved with the development of newer equipment, use of an algorithmic approach, and advancement in procedural techniques, CTO PCI has a higher rate of complication than does non-CTO PCI. Therefore, meticulous preprocedural planning before CTO PCI is paramount to improve success and reduce the risk of complications. In this report, we review multiple aspects of preprocedural CTO PCI planning, including procedural indications, efficacy, safety, diagnostic angiography, scoring tools for procedural success and risk prediction, and preprocedural use of computed tomography coronary angiography.