Chronic Total Occlusions: A Benign Entity or a “Perfect Storm” of Road Closures Waiting to Occur…?

Coronary blood flow may be regarded as a series of major roads supplying traffic to all key districts of a city. When rush hour ensues (akin to significant physical activity), demand on the roads increases exponentially. If the road infrastructure is suitably developed, the city roads cope, and traffic gridlock is averted. If, however, some of the major roads have a temporary reduction in the number of lanes because of roadworks (akin to, say, a coronary stenosis), the city continues to cope with the ensuing rush-hour traffic, albeit with more congestion (akin to angina). Enhanced traffic management systems (e.g., smart roads/traffic lights, akin to antianginals) may be sufficient to avoid heavy congestion. As the number of roadworks (coronary stenoses) increases, more severe traffic congestion occurs during rush hour (worsening angina), and the chances of traffic gridlock—when traffic flow exceeds capacity and the cars stop moving (akin to an ischemic malignant arrhythmia and/or cardiac arrest)—increases exponentially. [...]