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CTO operators develop several skills that translate in all aspects of non-CTO PCI. CTO PCI can significantly enhance the operator's armamentarium for treating complex lesions. 7. Time availability . Time is needed to attend courses, read, and get proctored. Also early in the learning curve CTO PCI cases can be long, often lasting 2-4 h each. This is a trial done in Europe, looking at patients who presented with STEMI and then had a subsequent CTO intervention on the non-infarct related artery. And what they showed basically, is no significant improvement in LV systolic function, which was sort of contrary to some of the data that I showed you so far, but there is something to be Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed (AMA CPT 2018 Professional Edition). Angiography during the procedure, used to monitor the course of the intervention, is considered part of the PCI and is not separately billable to Medicare. Coronary artery perforation is one of the most feared complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), as it can lead to pericardial effusion, tamponade, hemodynamic deterioration, need for emergency pericardiocentesis or surgery, or death.1 The incidence of perforation is higher in CTO PCI compared with non-CTO PCI, likely due to higher anatomic Barry F. Uretsky, Mohammad Marashdeh. Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO), defined as a total occlusion (with TIMI grade 0 flow) of > 3 months duration, is one of the most technically challenging coronary subsets. Some lesions have minimal antegrade flow. These lesions, often called CTOs or functional Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the buildup of the cholesterol-laden plaques that form due to atherosclerosis. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is evolving rapidly with development of novel equipment and optimization of various treatment algorithms [ 1, 2, 3 ]. At the same time, lesion complexity is increasing, requiring continual adaptation and technique optimization. Dr Emmanouil Brilakis, MD, PhD, FACC, FAHA, FESC, FSCAI is Director of the Center for Complex Coronary Interventions at the Minneapolis Heart Institute. Dr Brilakis graduated from Lycee Leonin de Patissia and received his medical degree from the National Kapodistrian University of Athens, Greece. He trained in Internal Medicine, Cardiovascular June 28, 2022—JenaValve Technology, Inc., a developer and manufacturer of transcatheter aortic valve replacement (TAVR) devices, announced results from the first commercial implantations of the Trilogy heart valve system in high-surgical-risk patients with severe symptomatic aortic stenosis (AS) or aortic regurgitation (AR) in Europe. Jun 28 In DECISION CTO study, PCI did not reduce the 4-year risk of MACE. However, nearly 20% of patients in t