1. The 2019 EURO CTO registry enrolled over 7,000 patients, with a significant increase in cases entered by associate members. 2. Despite increasing complexity with almost 40% requiring retrograde approaches, success rates continued rising to nearly 90% with low complications and decreasing radiation exposure. 3. Most procedures used soft wires initially but required stronger steerable wires to cross lesions. Dual lumen catheters were used in 14.2% of cases while IVUS was used in 16%.

1. EURO CTO registry 2019
and Future Projects
on behalf of
Sianos, Galassi, Garbo, Avran, Bufe
Werner, Reifart
& All the Club Members Contributing to the Registry

2. AGrowingAssociation

5. FullofNewActiveMembers

6. Changes in the Statute on Associate/Candidate
1. Every European interventional cardiologist with profound knowledge and skills in the area of the
association’s aims and who supports its aims can become member of the ECC. There are three types of
membership: members and candidate members. Members are highly experienced operators
recommended by two Board members. Candidates are CTO operators actively interested in CTO topics
as confirmed by 2 full members, the head of their cath lab and their CV. Affiliated members, without
voting rights, are CTO operators active in countries outside Europe actively involved in the educational
activities of the ECC, nominated by 2 full members.
2. The decision to accept a new member will be exercised by a majority decision of the Board. Candidate
members receive their access to register CTO cases in the ERCTO registry through the President or a
Board member assigned that task. They can become regular members after completing 300 CTO cases
and at least 50/year. The promotion will be decided by the Board with majority decision.
8. Candidate members receive the right to vote when they actively participate in the registry for two
years entering at least 50 cases a year.

7. FirstOperatorRetrograde

8. StablePercentageRetrogrades

9. TrendtoIncreasedComplexity

10. TrendtoLowerSuccessJ-CTO3-5v0-2

11. HighProceduralSuccess

12. Konstantinidis NV, …. Sianos et al, Circ Cardiovasc Interv.2018;11:e006229

13. LowComplicationRate

14. Konstantinidis NV, …. Sianos et al, Circ Cardiovasc Interv.2018;11:e006229

15. 12136 procedures by 23 operators between 2012 and 2017 within the
European Registry of CTO PCI (success improved from 87.7 to 92.2%:
decreased for AirKerma by 19.7%, and Dose Area Product by 28.5%)
Werner, Avran,
Mashayekhi et al
Trends in Radiation
Exposure During CTO:
A multicentre registry

16. FloppyWiresPreferredtoStart

17. GaiaMostSuccessfulFinalWire

18. GuidingCathDiameter(Anterograde?)

19. DualInjectionPlateauing;RadialIncreasing

20. LowPenetrationADR

21. LowUsageofIVUS

22. FrequentUseDualLumenMicrocatheter

23. Dual Lumen Catheter Consensus Document
Tajti, Garbo, Werner, Reifart, Di Mario, Mashayeshi, etc

24. New Statute: Point 7 (Board)
1. The board consists of the following Members: President, President Elect, 3 elected Board
Members, Treasurer, immediate Past-President. Former Past Presidents are invited to attend
the Board meetings but hold no voting rights.
2. The board represents the association judicially and out of court. Two members of the
board together can act as legal representatives, when needed.
3. Board members could be re-elected a further duration of 3 years (maximum consecutive
tenure 6 years).
4. The president will be elected by the General assembly. The president will remain in office until the
elected successor is due to follow
5. The board may nominate a secretary and administrative assistant
6. The board physically meets at least once a year and at least once every three
months via teleconference

25. CTO Definition
Narrowing and blood flow:
• Occlusion must total (100%)
• TIMI flow:
• TIMI flow through the CTO must be ZERO
• It will be accepted blood flow distal to the CTO if clearly coming from
collaterals (bridging, ipsi-lateral and/or contra-lateral)
• Absence of thrombus in the occluded segment
Lesions should be adjudicated to confirm if they were a CTO
Ybarra, Rinfret, Brilakis, Stone et al: CTO-ARC Definitions
finally approved in CIRCULATION

26. Proposals of New SubStudies
• From Industry: new devices –wires, microcatheters, accessories- :once they receive
CE mark why not reporting real-world indications performance and safety from the
largest ongoing CTO registry?)
• From Investigators: new techniques/devices: numbers make studies unbeatable.
Retrospective/prospective studies with set of new questions for interested members
• Regular update entries avoiding excessive multiplication of items
• Continue monitoring? Indications/success were nearly 100% correct in the last years

27. Srtauss, Knutson,
Cheema et al
The Canadian Multicenter
CTO Registry: 10-Year
Follow-up Results

28. ISCHEMIACTO
Ischemia-cto@clin.au.dk
Screening cohort
SAQ QoL  60 andCCS  1
Ischemia  10 % of LV
COHORT A
SAQ QoL < 60 and/or CCS  2
Ischemia > 5% of LV
COHORT B
CTO
OMT for 3 months
Ischemic testing
Symptoms?
Randomization
1200 patients
OMT PCI
Primary endpoint: MACCE
5 years (median)
COHORT C
Randomization
360 patients
Primary endpoint: SAQ QoL
6 months
OMT PCI
International RandomizedTrial on the Prognostic Effect of Revascularization
or Optimal MedicalTherapy of ChronicTotal Coronary Occlusions
Evald Høj Christiansen: PI
Ashkan Eftekhari: coPI
Emil Nielsen Holck:

29. ISCHEMIACTO
Ischemia-cto@clin.au.dk
0 10 20
Aarhus University Hospital, Skejby
Rigshospitalet, Copenhagen
Gentofte Hospital, Copenhagen
Odense University Hospital, Odense
Sahlgrenska University Hospital, Göteborg
Tampere University Hospital, Tampere
North-Estonia Medical Centre, Tallinn
 Enrolled patients N=216
 Randomized patients: n=95
 CohortA (prognostic arm): N=39
 Cohort B (symptomatic arm): N= 56
 Cohort C (observational arm): N=78
95
Study status

30. 2019 EuroCTO Registry: Conclusions
1. The ERCTO enrolled more than 7000 patients in 2019, with a remarkable increase
especially in the cases entered by Associate Members
2. Despite the continuous increase in CTO complexity with almost 40% requiring a
retrograde approach, success rate keeps increasing approaching 90%, with very
low incidence of complications and progressive decrease of radiation load
3. Most anterograde procedures are started with soft wires (XT, XTR, XTA) but more
steerable stronger wires are required to cross
4. Dual lumen catheters are used in 14.2% of the procedures, StingRay in 2.4%,
IVUS in 16%
5. The largest worldwide CTO Registry remains a goldmine of unique data to exploit

31. 2019 EuroCTO Registry: Conclusions
1. The ERCTO enrolled more than 7000 patients in 2019, with a remarkable increase
especially in the cases entered by Associate Members
2. Despite the continuous increase in CTO complexity with almost 40% requiring a
retrograde approach, success rate keeps increasing approaching 90%, with very
low incidence of complications and progressive decrease of radiation load
3. Most anterograde procedures are started with soft wires (XT, XTR, XTA) but more
steerable stronger wires are required to cross
4. Dual lumen catheters are used in 14.2% of the procedures, StingRay in 2.4%,
IVUS in 16%
5. The largest worldwide CTO Registry remains a goldmine of unique data to exploit