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In case of procedure failure: facilitating future success

WM Wilson, AJ Bagnall & JC Spratt

Current chronic total occlusion (CTO) success rates are approximately 80–85% in the hands of skilled operators [1]. The most common mode of failure is an inability to cross an occlusion with a coronary guidewire with reasons to abandon a case, including futility, reaching contrast or radiation dose thresholds, patient tolerability, time pressures on catheter laboratory use or significant procedural complications. If primary case failure looks likely, it is important to understand the ‘failure mode’ and identify modifiable contributors to failure, which may then be addressed to facilitate future procedural success. Prospective actions during the index procedure can potentially lead to subsequent spontaneous recanalization and/or enhance the success rates of a future attempt.