Treatment option approaches to the management of chronic total occlusions.

OPINION STATEMENT: You have a consultation from a 67-year-old patient with severe effort angina. Full-dose prescription could not relieve his symptoms. He had bypass surgery (coronary artery bypass graft [CABG]) more than 10 years ago. Saphenous vein graft (SVG) to a big right coronary artery (RCA) was recently occluded. SVG to a small circumflex artery was occluded before. Left internal mammary artery graft to left anterior descending artery was nicely patented. His native RCA has been occluded since before he received CABG. How can we treat these patients? Among the treatment options between redo CABG and percutaneous coronary intervention (PCI) for the chronic total occlusion of his native RCA, I propose choosing the latter option.