Jozef Pacák, Viliam Fridrich, Martin Gočár, Stanislav Mizera, Branislav Liška
Chronic total occlusion (CTO) of the coronary arteries is defined as a lesion with complete stop of the antegrade flow of the contrast agent old more than 3 months. Histologic and pathologic findings have showed that in the presence of angiographic occlusion we can find micro-channels in approximately half of the cases. It can help to cross the CTO lesion with the guide-wire during percutaneous coronary revascularization of the occluded artery (CTO-PCI). CTO can be found in approximately up to the 30 % of the diagnostic coronary angiography but the CTO-PCI is attempted in only a small number of lesions despite the data from the large registries of unselected groups of patients with the CTO have approved the benefit of elimination or mitigation of symptoms, reduction of the need of the coronary artery bypass operations and improving the long term prognosis. The main reason for a low frequency of CTO-PCI is the lower success rate of the PCI in that subset lesion. But specialized centers show an improvement in the success rate of the CTO-PCI up to the 80 %. In the National Institute of Cardiovascular Diseases the rate of the CTO-PCI is low, 3 %, despite the high frequency of the successful PCI CTO procedures (88.7 %). This fact shows the high threshold for CTO-PCI. According to EuroCTO Club Recommendations, it is useful to create skilled, sub-specialized CTO/PCI.