Optimal Approach in Staged Chronic Total Occlusion Percutaneous Coronary Intervention.

Purpose of review: To discuss the optimal timing of staged chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS), multiple CTOs and after a CTO modification procedure.

Recent findings: In patients with acute coronary syndromes CTO PCI should be performed as part of a complete revascularization strategy within a few weeks or months from the initial presentation. In patients who undergo CTO modification procedures, such as subintimal tracking and re-entry (STAR) earlier re-intervention (within 1-2 months) is better than later re-intervention. Staged intervention is preferred in most patients who need PCI of more than one CTO to minimize the risk of complications. The optimal timing of CTO intervention as part of a complete revascularization strategy remains unknown, as does the optimal timing of repeat intervention after a CTO modification procedure, though earlier is likely better than later in both cases. PCI of more than one CTO in the same patient should also be staged for safety reasons.