Chronic Total Occlusion Percutaneous Coronary Intervention: Mindset, Culture, and Continuous Improvement

The development of complex and higher risk indicated procedures (CHIP) and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has brought along new challenges in terms of operator training. While the technical aspect of learning CHIP/CTO PCI have been described in detail, very little has been discussed on the mental skills that the operator must possess or develop to be successful.Moreover, an at least equally important piece to CHIP/CTO PCI program development is the professional culture of the institution where these complex procedures are performed, as this can mark the difference between a thriving and long-lasting program and one that is quickly bound to fail.This article analyzes the mental attributes of the CHIP/CTO PCI operator and outlines several leadership principles that can be applied to foster a growth culture and develop a thriving program.