Proctorship in Chronic Total Occlusion Percutaneous Coronary Intervention in Low- and Middle-Income Countries: Challenges, Ethics, and Safety Implications—A Perspective from High-Volume CTO PCI Proctors in Latin America

This perspective explores the contemporary role of CTO PCI proctorship in LMICs, focusing on structural constraints, operator heterogeneity, recurrent procedural pitfalls, human factors, and ethical considerations. We propose a regionalized, center-focused model as a more sustainable strategy for capacity building, patient safety, and long-term program development. Although grounded in Latin American experience, the structural challenges and proposed solutions are broadly applicable to any setting where procedural complexity outpaces institutional readiness.