Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone.

Our experience supports the percutaneous extraction of CS leads as a safe and effective procedure including the utility of laser when necessary.

Although FFR is reported to be independent of changing hemodynamics, 10 it is intimately related to total coronary flow through a stenosis, which in turn is related to perfused myocardial mass. 11 In keeping with this, there have been several reports of large increases in collateral donor vessel FFR associated with PCI of a concomitant CTO and, therefore, reduction in perfused myocardium.12-16 However, there is inherent variability to FFR measurement, 10 and therefore selective reporting and publication bias might have exaggerated the magnitude (or even presence) of this phenomenon in the reported cases.Background-The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO. Methods and Results-In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity-pressure gradient relation were calculated.