How to successfully approach CTO interventions: a step-by-step approach

Elliot Smith, Thomas Hovasse and Roberto Garbo discuss a comprehensive, step-by-step approach to CTO interventions, providing structured guidance on navigating CTOs in a safe and effective way.

The discussion begins with angiographic assessment, emphasising the importance of identifying key anatomical features upfront. Based on this evaluation, operators determine the most appropriate strategy—typically beginning with an antegrade approach, with readiness to escalate to retrograde or dissection techniques depending on case complexity and progression.

The panel outlines essential tools for CTO procedures: guiding catheters, wires (from soft to stiff), and microcatheters, while also addressing how these tools are introduced into routine practice. Attention is given to operator experience, decision-making flexibility, and technique sequencing.

In parallel, the importance of progressive skill acquisition is highlighted. Failure is positioned not as an endpoint, but as a learning opportunity—integral to refining technique and gaining confidence.

This interview was filmed at EuroPCR 2025: see more videos here.