{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:51:53Z","timestamp":1760057513581,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,16]],"date-time":"2025-02-16T00:00:00Z","timestamp":1739664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health, Ricerca Corrente 2025, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>The diagnosis of chronic total occlusion (CTO), characterized by the complete obstruction of a coronary artery for at least three months, remains challenging and can be entirely asymptomatic. Since the indications for performing a recanalization procedure for CTO do not originate from randomized controlled trials, this study aimed to assess the indications, management, and procedural outcomes of patients undergoing percutaneous revascularization (PCI) for a CTO, ensuring that the population was as uniform as possible regarding technologies and methodological approaches. Forty-one consecutive patients who underwent PCI for CTO recanalization were enrolled from January 2021 to 2024. Additional outcomes included mortality, major adverse cardiovascular events, and the presence of residual cardiac symptoms, with a median follow-up of 449 days and an interquartile range of 230\u2013643 days. Our real-life study confirmed that PCI for CTO has a high success rate and a low incidence of major complications.<\/jats:p>","DOI":"10.3390\/jcdd12020075","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T11:31:17Z","timestamp":1739791877000},"page":"75","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indications, Management, and Short- and Medium-Term Outcomes of Patients with Chronic Coronary Occlusion Treated with Percutaneous Revascularization\u2014A Single-Center Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Lucia","family":"Barbieri","sequence":"first","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-8400","authenticated-orcid":false,"given":"Gabriele","family":"Tumminello","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Mafrici","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Pasero","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Mircoli","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Gobbi","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5704-9230","authenticated-orcid":false,"given":"Alessandra S.","family":"Rizzuto","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5166-0899","authenticated-orcid":false,"given":"Stefano","family":"Carugo","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcin.2021.09.027","article-title":"Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention","volume":"15","author":"Azzalini","year":"2022","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0735-1097(97)00035-1","article-title":"Histologic Correlates of Angiographic Chronic Total Coronary Artery Occlusions Influence of Occlusion Duration on Neovascular Channel Patterns and Intimal Plaque Composition","volume":"29","author":"Srivatsa","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/eurheartj\/ehl446","article-title":"Importance of collateral circulation in coronary heart disease","volume":"28","author":"Berry","year":"2007","journal-title":"Eur. Hear. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1002\/(SICI)1522-726X(200003)49:3<258::AID-CCD7>3.0.CO;2-L","article-title":"Percutaneous transluminal coronary angioplasty of chronic total occlusions. Determinants of primary success and long-term clinical outcome","volume":"49","author":"Noguchi","year":"2000","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jcin.2010.09.024","article-title":"Predicting Successful Guidewire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30 Minutes The J-CTO (Multicenter CTO Registry in Japan) Score as a Difficulty Grading and Time Assessment Tool","volume":"4","author":"Morino","year":"2011","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1161\/CIRCULATIONAHA.120.046754","article-title":"Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations","volume":"143","author":"Ybarra","year":"2021","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.hlc.2019.05.188","article-title":"Retrograde Versus Antegrade Approach for Coronary Chronic Total Occlusion in an Algorithm-Driven Contemporary Asia-Pacific Multicentre Registry: Comparison of Outcomes","volume":"29","author":"Wu","year":"2020","journal-title":"Heart Lung Circ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"535","DOI":"10.4244\/EIJ-D-21-01117","article-title":"Recanalisation of coronary chronic total occlusions","volume":"18","author":"Mashayekhi","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4244\/EIJV8I1A21","article-title":"Recanalisation of Chronic Total Coronary Occlusions: 2012 Consensus Document from the EuroCTO Club","volume":"8","author":"Sianos","year":"2012","journal-title":"EuroIntervention"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.jcin.2018.04.017","article-title":"The IMPACTOR-CTO Trial","volume":"11","author":"Obedinskiy","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1161\/CIRCULATIONAHA.118.031313","article-title":"Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion","volume":"139","author":"Lee","year":"2019","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1536\/ihj.20-427","article-title":"Randomized Controlled Comparison of Optimal Medical Therapy with Percutaneous Recanalization of Chronic Total Occlusion (COMET-CTO)","volume":"62","author":"Juricic","year":"2021","journal-title":"Int. Hear J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2016.07.744","article-title":"Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial","volume":"68","author":"Henriques","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1093\/eurheartj\/ehab271","article-title":"Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous cor-onary interventions: A Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)","volume":"42","author":"Bulluck","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e174","DOI":"10.4244\/EIJ-D-23-00749","article-title":"Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery","volume":"20","author":"Galassi","year":"2024","journal-title":"EuroIntervention"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1161\/CIRCULATIONAHA.119.039797","article-title":"Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention: A Global Expert Consensus Document","volume":"140","author":"Brilakis","year":"2019","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.jacc.2021.09.006","article-title":"2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Lawton","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.cjca.2016.04.007","article-title":"Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry","volume":"32","author":"Danek","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.jacc.2011.12.007","article-title":"Current perspectives on coronary chronic total occlusions: The Canadian multicenter chronic total occlusions registry","volume":"59","author":"Fefer","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1093\/eurheartj\/ehy220","article-title":"A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions","volume":"39","author":"Werner","year":"2018","journal-title":"Eur. Hear. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/jce.12622","article-title":"Impact of a Chronic Total Occlusion in an Infarct-Related Artery on the Long-Term Outcome of Ventricular Tachycardia Ablation","volume":"26","author":"Paglino","year":"2015","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jcin.2017.02.008","article-title":"Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study): Insights From Coronary Angiogram and Electrogram Analysis","volume":"10","author":"Paglino","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.carrev.2023.04.001","article-title":"Impact of Percutaneous Intervention Compared to Pharmaceutical Therapy on Complex Arrhythmias in Patients with Chronic Total Coronary Occlusion. Rationale and Design of the CTO-ARRHYTHMIA Study","volume":"54","author":"Christensen","year":"2023","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e006229","DOI":"10.1161\/CIRCINTERVENTIONS.117.006229","article-title":"Temporal trends in chronic total occlusion interventions in Europe: 17626 procedures from the European Registry of Chronic total occlusion","volume":"11","author":"Konstantinidis","year":"2018","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_26","first-page":"E61","article-title":"Equipment Utilization in Chronic Total Occlusion Percutaneous Coronary Interventions: Update From the PROGRESS-CTO Registry","volume":"35","author":"Kostantinis","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Danek, B.A., Karatasakis, A., Karmpaliotis, D., Alaswad, K., Yeh, R.W., Jaffer, F.A., Patel, M.P., Mahmud, E., Lombardi, W.L., and Wyman, M.R. (2016). Development and validation of a scoring system for predicting periprocedural complications during percutaneous coronary interventions of chronic total occlusions: The prospective global registry for the study of chronic total occlusion intervention (progress cto) complications score. J. Am. Heart Assoc., 5.","DOI":"10.1161\/JAHA.116.004272"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"42","DOI":"10.31083\/j.rcm2302042","article-title":"Drug-coated balloon for the management of coronary chronic total occlusions","volume":"23","author":"Chaddad","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2217\/ica.13.48","article-title":"Complications of chronic total occlusion percutaneous coronary intervention","volume":"5","author":"Patel","year":"2013","journal-title":"InterVentional Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jcin.2012.10.011","article-title":"Angiographic Success and Procedural Complications in Patients Undergoing Percutaneous Coronary Chronic Total Occlusion Interventions A Weighted Meta-Analysis of 18,061 Patients From 65 Studies","volume":"6","author":"Patel","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1016\/j.jacc.2009.12.038","article-title":"Efficacy and Safety of Drug-Eluting Stents in Chronic Total Coronary Occlusion Recanalization: A Systematic Review and Meta-Analysis","volume":"55","author":"Colmenarez","year":"2010","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/2\/75\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:35:38Z","timestamp":1760027738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/2\/75"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,16]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcdd12020075"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12020075","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2025,2,16]]}}}