Cheung Stephen C W, Lim Michael C L, Chan Carmen W S
Department of Radiology, Queen Mary Hospital, HKSAR, PR China.
Singapore Heart, Stoke and Cancer Center, Singapore.
Heart Asia. 2010 Nov 8;2(1):122-5. doi: 10.1136/ha.2010.002261. eCollection 2010.
Revascularisation by percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) is often a technically challenging procedure. The manipulation of wires and devices through a CTO during PCI without any means to visually identify vessel-wall boundaries involves an inherent risk of complications such as arterial dissection, perforation and cardiac tamponade. With the tremendous advances in multidetector CT technology and the popularity of utilising coronary CT angiogram (CCTA) for a workup of chest pain patients, an increasing number of CTO cases are being encountered. Therefore, the primary goal of CCTA for imaging in CTOs involves identifying the presence and locations of CTO as well as predicting the potential clinical benefits derived from revascularisation of the occluded segment. The secondary goal includes preprocedural planning to shorten procedure times, visualisation of the procedure in predicting the ease with which a CTO can be crossed and the frequency of procedure-related complications such as contrast nephropathy and radiation skin injury. Apart from these, CCTA also plays a role in postprocedural assessment of the revascularised arterial segments and long-term follow-up on the patency of coronary stents.
在慢性完全闭塞病变（CTO）中，经皮冠状动脉介入治疗（PCI）实现血管再通往往是一项技术上具有挑战性的操作。在PCI过程中，在没有任何手段能直观识别血管壁边界的情况下，通过CTO操纵导丝和器械存在诸如动脉夹层、穿孔和心脏压塞等并发症的固有风险。随着多排CT技术的巨大进步以及利用冠状动脉CT血管造影（CCTA）对胸痛患者进行检查的普及，遇到的CTO病例越来越多。因此，CCTA用于CTO成像的主要目标包括确定CTO的存在和位置，以及预测闭塞节段血管再通可能带来的临床益处。次要目标包括术前规划以缩短手术时间，在预测CTO能否顺利通过的难易程度以及诸如造影剂肾病和放射性皮肤损伤等与手术相关并发症的发生频率方面对手术进行可视化。除此之外，CCTA在血管再通动脉节段的术后评估以及冠状动脉支架通畅情况的长期随访中也发挥作用。
