Chronic total occlusion percutaneous coronary intervention: 2026 update.
Authors
Affiliations (28)
Affiliations (28)
- Bahcesehir University School of Medicine, Istanbul, Turkey.
- SUNY Downstate Health Sciences University, Department of Cardiology, Brooklyn, New York; Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
- Prisma Health, Columbia, South Carolina.
- Division of Cardiovascular Medicine, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
- Cardiovascular Division, Saitama-Sekishinkai Hospital, Saitama, Japan.
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
- Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
- Wellspan York Hospital, York, Pennsylvania.
- Texas Health Presbyterian Hospital, Dallas, Texas.
- Maria Vittoria Hospital, Torino, Italy.
- Memorial Bahcelievler Hospital, Istanbul, Turkey.
- Biruni University Medical School, Istanbul, Turkey.
- Weill Cornell Medical Center, New York, New York.
- Emory University Hospital Midtown, Atlanta, Georgia.
- Emory University Hospital Midtown, Atlanta, Georgia, USA.
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
- Athens Naval and Veterans Hospital, Athens, Greece.
- Department of Clinical and Experimental Medicine, University of Florence, Careggi Hospital, Florence, Italy.
- Department of Clinical and Experimental Medicine, University of Florence, Careggi Hospital, Florence, Italy; Royal Brompton Hospital, London, United Kingdom.
- University Heart Center Freiburg, Bad Krozingen, Germany.
- Valenciennes Hospital, Valenciennes, France.
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami, Florida.
- University Heart Center, Goethe University, Frankfurt/Main, Germany.
- Department of Cardiology, CHU Helora Jolimont Hospital, La Louviere, Belgium.
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota. Email: [email protected].
Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is continually evolving through improvements in strategy, imaging, and equipment. This review provides a summary of the published literature in CTO PCI between September 2023 and April 2025, categorized by procedural outcomes, techniques, complications, and ongoing studies. Recent multicenter analyses report technical success rates exceeding 90% in expert centers, accompanied by significant reductions in angina and dyspnea at long-term follow-up. Despite higher complexity, radiation exposure has significantly decreased during the past decade as a result of equipment upgrades and operator awareness. Procedural refinements such as the use of coronary computed tomography for guidance, intravascular ultrasound guided re-entry, hydrodynamic contrast recanalization, novel retrograde techniques, and artificial intelligence-based tools are improving success and safety. Ongoing randomized trials and large-scale registries will continue to shape practice patterns and refine strategy selection in CTO PCI.