• biomarker
• chronic total occlusion
• coronary artery disease
• percutaneous coronary intervention
• prognosis

Treatment of coronary chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has rapidly increased during the past decades. Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success. The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently, has led to an exponential increase in the number of CTO-PCI procedures, even if are still underutilized. It has been widely demonstrated that complete coronary revascularization, achieved by either coronary artery bypass graft or PCI, is associated with prognostic improvement, in terms of increased survival and reduction of major adverse cardiovascular events. The application of “contemporary” strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit, even in high-risk patients or complex coronary anatomy with CTO. The increasing success of CTO-PCI, allowing a complete or reasonable incomplete coronary revascularization, is enabling to overcome the last great challenge of interventional cardiology, adding a “complex” piece to “complete” the puzzle.

• Chronic total occlusion
• Percutaneous coronary intervention
• Complete revascularization
• Prognosis
• Coronary artery disease

• Coronary artery bypass grafting
• Coronary artery disease
• Hybrid coronary revascularization
• Percutaneous coronary intervention

Acute coronary syndromes complicated by cardiogenic shock are associated with high mortality, and patients are definitely considered at high procedural risk. We present here the 5-year success of full percutaneous management of a young patient in cardiogenic shock with acute and chronic coronary artery disease as well as significant mitral regurgitation. Whereas the benefit of culprit lesion coronary revascularization is well established, evidence supporting chronic total occlusion revascularization in the acute setting remains poor. Percutaneous management of acute mitral regurgitation with cardiogenic shock is a viable option in patients with recurrent pulmonary edema.