Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: A Comprehensive Review.

Chronic Total Occlusions (CTOs) are complete coronary artery blockages persisting for more than three months. CTOs present significant technical and hemodynamic challenges during prercutaneous coronary intervention (PCI). CTO PCI can substantially improve symptoms, quality of life, and left ventricular function. However, CTO PCI is associated with higher procedure complications rates. Mechanical Circulatory Support (MCS) devices, such as Impella, TandemHeart, and VA-ECMO, have emerged as critical tools for high-risk patients. Indications for MCS include severe left ventricular dysfunction, complex coronary anatomy, and multiple comorbidities. Evidence from clinical trials, meta-analyses, and regiestries demonstrate that prophylactic MCS use can improve procedural success. Careful patient selection and risk stratification are essential to maximize the benefits of MCS in CTO PCI.