Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1019-46. doi: 10.1002/ccd.22161.
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains one of the major challenges in interventional cardiology. The appropriate use of the rapidly increasing range of tools available to interventional cardiologists is bringing more and more CTOs into the 'treatable' category. The bar has now been raised to 80% success rates by some expert operators around the world, which, in our view, cannot be achieved without a thorough understanding of technique and technical know-how. CTO procedures are increasingly becoming a sub-specialist field within interventional cardiology and we would encourage centers to consider appointing 'super-specialists' who are able to concentrate experience and expertise in this area. In this paper we detail the principal characteristics of the over the wire balloons, microcatheters and guidewires at present available, the most popular and recent of which are listed in Table 1 and 2. The knowledge and the specific choice of these materials and the criteria for selection of your guidewire or microcatheter can mean the difference between success and failure. Moreover, we discuss on the most important and groundbreaking techniques to approach a CTO. Finally, considering the greater risk of coronary perforation related to a CTO procedure compared to routine PCI, we describe which are best strategy and devices for treating coronary perforations and other major complications.
经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）仍然是介入心脏病学的主要挑战之一。介入心脏病学家可使用的工具范围迅速扩大，越来越多的 CTO 可被归类为“可治疗”。现在，全球一些专家操作者将成功率提高到 80%，我们认为，如果没有对技术和技术诀窍的透彻理解，就无法实现这一目标。CTO 手术越来越成为介入心脏病学中的一个亚专科领域，我们鼓励中心考虑任命“超级专家”，他们能够在该领域集中经验和专业知识。在本文中，我们详细介绍了目前可用的导丝、微导管和球囊的主要特点，其中最受欢迎和最新的特点列于表 1 和 2。这些材料的知识和具体选择以及导丝或微导管的选择标准可能意味着成功与失败之间的区别。此外，我们还讨论了接近 CTO 的最重要和最具开创性的技术。最后，考虑到 CTO 手术与常规 PCI 相比，冠状动脉穿孔的风险更高，我们描述了治疗冠状动脉穿孔和其他主要并发症的最佳策略和设备。
