Chronic Total Occlusion Percutaneous Coronary Intervention: A Consensus of the National Heart Center in Collaboration With the Saudi CTO Club of the Saudi Arabian Cardiac Interventional Society

Objective: Chronic total occlusion (CTO) is one of the most complex and technically demanding percutaneous coronary interventions (PCI). Over the last two decades, technological and procedural advancements have significantly improved clinical outcomes. However, CTO-PCI practice and outcomes remain suboptimal with a lack of standardized approaches. Methods: The Saudi CTO Club has been actively working to enhance collaboration among CTO operators throughout the region. The National Heart Center (NHC), in collaboration with the Saudi Arabian Cardiac Interventional Society (SACIS), convened national experts to develop a consensus document and workflow for integrating CTO-PCI into clinical practice in Saudi Arabia. This consensus document consolidates current evidence from international guidelines and the recommendations are tailored to address region-specific considerations. The document delineates clear protocols for clinical indications, procedural techniques, and the mitigation of complications in CTO-PCI. Results: In this consensus, 14 statements are discussed considering scientific evidence and agreed upon for CTO-PCI. These statements covered four pillars: i) Indications; ii) Evaluation; iii) CTO-PCI technical principles; and iv) Safety and complications. Conclusion: This consensus provides a framework for recommendations to guide the treatment of patients, the development of CTO programs, and the training of new CTO-PCI operators.