Chronic total occlusion (CTO)

Chronic total occlusion (CTO) is defined by the complete occlusion of a coronary artery over a period of more than 3 months. The prevalence is stated in the literature to be up to 30%. CTO poses a particular challenge for interventional treatment and, due to the special anatomy of the lesions, many patients cannot be treated at all or can only be treated surgically.

Special challenges compared to conventional interventions are the wire passage and stent implantation on the one hand and the increased specific material requirements and the longer examination and intervention time on the other. The technical complexity with high demands on the examiner, the costs incurred (material, personnel, examination time) and an increased failure rate have historically led to a reduction in revascularisation attempts.
The increasing experience of the investigators and the constant further development of the material have led to enormous progress in dealing with the particular challenges of CTO. The development of new revascularisation techniques with state-of-the-art equipment has also made it possible to overcome technical difficulties. The establishment of CTO treatment algorithms and the application of advanced strategies in combination with safety guidelines have established a new era of percutaneous intervention in the field of CTO.
Our Department of Cardiology at the Benjamin Franklin Campus has specific expertise in these particularly complex interventions based on many years of experience and the continuous further development of the programme and places particular emphasis on continuous further training through national, European and international exchange, for example with Japan and the USA. We also have all the necessary material and technical resources to perform both antegrade and retrograde canalisations of CTOs.
With the help of state-of-the-art CT imaging and specific software connections, the safety of the intervention and its success rates can also be increased. We also have access to all methods of intravascular imaging and lesion preparation (IVUS, OCT, rotablation, lithotrypsy) and, if necessary, haemodynamic stabilisation (VA-ECMO, Impella CP, Impella 2.5, Impella RP).
An internal quality and success control system also contributes to patient safety.