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Broadly, the physiological assessment of a CTO relies on assessing the function and regression of collaterals, the assessment of the microcirculation, the impact of collateral steal as well as assessing the severity of a lesion in the donor vessel (the vessel supplying the majority of collaterals to the CTO). Recent studies have shown that physiological assessment of the donor vessel in the setting of a CTO may overestimate the severity of stenosis, and that after revascularization of a CTO, the index of ischemia may increase, potentially altering the need for revascularization. In this review article, we present the current literature on physiological assessment of patients with a CTO, management recommendations and identify areas for ongoing research.<\/jats:p>","DOI":"10.1161\/circinterventions.119.007813","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T09:00:17Z","timestamp":1562317217000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion"],"prefix":"10.1161","volume":"12","author":[{"given":"Usaid K.","family":"Allahwala","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.)"},{"name":"Sydney Medical School, University of Sydney, NSW, Australia (U.K.A., R.B.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanouil 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