Abdel-Karim Abdul-Rahman R, Lombardi William B, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Cardiology, St. Joseph's Hospital, Bellingham, Washington, USA.
Cardiovasc Revasc Med. 2011 May-Jun;12(3):170-176. doi: 10.1016/j.carrev.2010.08.002. Epub 2010 Oct 20.
Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR).
We reviewed the procedural techniques and outcomes of 21 consecutive interventions in CTOs due to ISR.
Mean age was 60±8 years, and all patients were men. The target lesion was located in the right coronary artery in 38%, left anterior descending or diagonal in 48%, or circumflex/obtuse marginal in 14%. One CTO lesion was treated in each patient. Two patients (10%) had prior unsuccessful attempt for CTO intervention and 14% had prior coronary artery bypass graft surgery. The average CTO age was 6.3±4.6 years. The overall ISR CTO procedural success rate was 71%. Procedural failure was due to inability to cross the CTO lesion in all unsuccessful cases. Failure to cross in CTOs located in the left anterior descending artery was due to the presence of a large side branch proximal to the CTO, whereas in the right coronary artery it was due to tortuosity. Retrograde interventions were attempted in four patients and were successful in one.
Success rates for ISR CTO interventions remain relatively low due to failure to cross the lesion. Several factors, such as long occlusion time, tortuosity, and presence of a large side branch proximal to the CTO may be associated with ISR CTO crossing failure.
关于因支架内再狭窄（ISR）导致的慢性完全闭塞（CTO）的治疗，现有数据有限。
我们回顾了21例因ISR导致的CTO连续介入治疗的操作技术和结果。
平均年龄为60±8岁，所有患者均为男性。靶病变位于右冠状动脉的占38%，位于左前降支或对角支的占48%，位于回旋支/钝缘支的占14%。每位患者治疗一处CTO病变。2例患者（10%）既往CTO介入尝试失败，14%的患者既往接受过冠状动脉旁路移植术。CTO平均病程为6.3±4.6年。ISR-CTO介入治疗的总体成功率为71%。所有介入失败病例的原因均为无法穿过CTO病变。位于左前降支的CTO无法穿过是由于CTO近端存在大的侧支血管，而位于右冠状动脉的CTO无法穿过是由于血管迂曲。4例患者尝试了逆向介入治疗，1例成功。
由于无法穿过病变，ISR-CTO介入治疗的成功率仍然相对较低。几个因素，如闭塞时间长、血管迂曲以及CTO近端存在大的侧支血管，可能与ISR-CTO无法穿过有关。
