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Myocardial revascularisation for chronic total coronary oclusion

  • Natural history and the role of medical therapy, presented byJS Hochman (New York, US) - Slides
  • Role of percutaneous intervention, presented by G S Werner (Darmstadt, DE) - Slides
  • Role of surgical intervention, presented by P H Kolh (Liege, BE) - Slides
  • Future developments, presented by S T Lim (Singapore, SG) - Slides
Chronic Ischaemic Heart Disease (IHD)

The good attendance at this early session indicted the importance of this topic and the excellent quality of the speakers.

Natural history and the role of medical therapy

JS Hochman first discussed the natural history and the role of medical therapy. Emphasising the lack of RCT data, she dealt with the large meta-analysis published in AHJ 2010 and then went on to share some as yet unpublished, long term data from the OAT trial.

Role of percutaneous intervention

GS Werner discussed the role of PCI in CTO pointing out how much of a problem CTO presents in terms of revascularisation. 30 % of cath lab cases and > 3O o/o have MVD. Persistent patency is the key to benefit and this improves with experience and expertise. DES have a major role to play.

Role of surgical intervention

Prof Kohl dealt with the role of surgical intervention in CTO and reminded us that patients with a SYNTAX score of >22 should be considered for surgery, particularly if CTO is present. This is particularly relevant in terms of LAD revascularisation

Future developments

S T Lim then spoke of future developments and concentrated on the role that newer imaging technologies will have on improving outcomes.This include using MRI for vulnerability and IVUS or guidance during the procedure.

In all an excellent session. CTO remains challenging; requires patience and expertise; there is a need for RCT and long term patency is the key to success




Myocardial revascularisation for chronic total coronary oclusion

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.