PCI of a CTO in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate exper- tise.699 703 (Level of Evidence: B) See Online Data Supplements 26 to 28 for additional data regarding CTOs. Approximately one third of patients with suspected CAD who undergo coronary angiography have 1 CTO (defined as occlusion of a duration 3 months).704 Although stress- induced ischemia can be elicited in the majority of patients with CTO despite the presence of collaterals,706,707 only 8% to 15% of these patients undergo PCI.708,709 The disparity between the frequency of CTOs and percutaneous treatment underscores not only the technical and procedural complex- ities of this lesion subtype but also the clinical uncertainties regarding which patients benefit from CTO revascularization. Studies suggest that patients who undergo successful, rather than failed, recanalization of CTOs fare better in terms of symptom status and need for CABG,699 as well as LV function.710 However, the impact of successful CTO recana- lization on long-term survival remains unsettled.701,711,712 The decision to try PCI for a CTO (versus continued medical therapy or surgical revascularization) requires an individual- ized risk-benefit analysis encompassing clinical, angio- graphic, and technical considerations. Consultation with a cardiothoracic surgeon and use of the Heart Team approach in cases of CTO in which a large territory is subtended and/or multivessel CAD is present are frequently done. From a technical perspective, successful recanalization of CTOs has steadily increased over the years because of adoption of dedicated wires, novel techniques, and increased operator experience.702 In patients who undergo successful CTO recanalization, use of DES significantly reduces the need for repeated target-vessel revascularization, compared with BMS and balloon angioplasty, without compromising 5.8.2. SVGs: Recommendations Class I 1. 