Nozaki Tokushukai Hospital, Nagoya Tokushukai General Hospital and Osaka University, Osaka, Japan.
JACC Cardiovasc Interv. 2011 Sep;4(9):941-51. doi: 10.1016/j.jcin.2011.06.011.
Currently, successful treatment of chronic total occlusion (CTO) seems markedly improved, due to several new techniques and dedicated device developments. However, this improved success rate is often limited to procedures performed by skilled, highly experienced operators. To improve the overall success rate of percutaneous coronary intervention of CTO from a worldwide perspective, a deeper understanding of CTO histopathology might offer insights into the development of new techniques and procedural strategies. In this review, CTO histopathology and wire techniques are discussed on the basis of the fundamental concepts of antegrade and retrograde approaches. Although details pertaining to wire manipulation are very difficult to explain objectively, we tried to describe this as best as possible in this article. Finally, a systematic review of the current standard CTO strategy is provided. Hopefully, this article will enhance the understanding of this complex procedure and, consequently, promote safe and effective CTO-percutaneous coronary intervention for patients who present with this challenging lesion subset.
目前，由于一些新技术和专用设备的发展，慢性完全闭塞（CTO）的成功治疗似乎明显改善。然而，这种成功率的提高往往仅限于熟练、经验丰富的操作人员进行的手术。为了从全球角度提高 CTO 经皮冠状动脉介入治疗的整体成功率，深入了解 CTO 的组织病理学可能有助于开发新技术和手术策略。在这篇综述中，根据顺行和逆行方法的基本概念讨论了 CTO 的组织病理学和导丝技术。尽管导丝操作的细节很难客观地解释，但我们在本文中尽力尽可能详细地描述了这一点。最后，提供了当前 CTO 标准策略的系统回顾。希望本文能增强对这一复杂手术的理解，从而为患有这种具有挑战性病变的患者提供安全有效的 CTO 经皮冠状动脉介入治疗。
