fig1

Figure 1. Approaches to hybrid CTO PCI and CABG. Patients presenting with multivessel coronary artery disease and at least one CTO are discussed by the heart team to decide on the most appropriate revascularization strategy considering SYNTAX score, CTO location, CTO PCI and CABG technical difficulty, and comorbidities. Revascularization approaches are to be discussed with consideration of hybrid revascularization for patients with non-LAD CTO lesions amenable to PCI, where LIMA-LAD (ideally minimally invasive TECAB or MIDCAB) is feasible as well. Timing of CTO PCI and CABG, as well as DAPT plan, should also be addressed by the heart team. CTO: Chronic total occlusion; PCI: percutaneous coronary intervention; CABG: coronary artery bypass grafting; LIMA: left internal mammary artery; LAD: left anterior descending artery; TECAB: totally endoscopic coronary artery bypass; MIDCAB: minimally invasive direct coronary artery bypass; DAPT: dual-antiplatelet therapy; LVEF: left ventricular ejection fraction.