Gülker Jan-Erik, Bansemir Lars, Klues Heinrich G, Bufe Alexander
Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany.
Heart Centre Niederrhein, Department of Cardiology, HELIOS Clinics Krefeld, Krefeld, aGermany; Institute for Heart and Circulation Research, University of Cologne, Kerpener Straße 62 50937, Cologne, aGermany; Witten/Herdecke University, Witten, aGermany.
J Saudi Heart Assoc. 2017 Apr;29(2):110-115. doi: 10.1016/j.jsha.2016.08.003. Epub 2016 Aug 20.
Percutaneous coronary intervention (PCI) of total chronic coronary occlusion (CTO) still remains a major challenge. The prevalence of a CTO has been reported to be up to 30% among patients with a clinical indication for coronary angiography. Progress has been made with further advanced interventional techniques and continuously sophisticated interventional tools. Nevertheless the number of interventions carried out to recanalize a CTO is less than 10% of all procedures. Benefits of a successful CTO recanalization include relief of angina pectoris and ischemia-related dyspnea, substantial improvement in left ventricular function and, avoidance of surgery treatment. A vast variety of new CTO PCI techniques and materials has been introduced into clinical practise and pushed success rates of reopening a CTO up to around 90% in experienced hands. Particulary the introduction of the retrograde technique was a milestone. New developed microcatheters and special polymer coated wires allow to recanalize via small collaterals and vessels. Other tools such as intravascular ultrasound (IVUS) and multislice computertomography (MSCT) help to identify the anatomy and the characteristic of the lesions. Any invasive cardiac center should adopt CTO PCI procedures as standard therapy.
This review wants to assess and describe the latest development in CTO recanalization strategies.
完全慢性冠状动脉闭塞（CTO）的经皮冠状动脉介入治疗（PCI）仍然是一项重大挑战。据报道，在有冠状动脉造影临床指征的患者中，CTO的患病率高达30%。随着进一步先进的介入技术和不断复杂的介入工具的出现，已经取得了进展。然而，为使CTO再通而进行的介入治疗数量不到所有手术的10%。成功使CTO再通的益处包括缓解心绞痛和缺血相关的呼吸困难、显著改善左心室功能以及避免手术治疗。各种各样的新型CTO PCI技术和材料已被引入临床实践，并使经验丰富者重新开通CTO的成功率提高到约90%。特别是逆行技术的引入是一个里程碑。新开发的微导管和特殊聚合物涂层导丝能够通过小的侧支血管和血管进行再通。其他工具，如血管内超声（IVUS）和多层计算机断层扫描（MSCT），有助于识别病变的解剖结构和特征。任何侵入性心脏中心都应采用CTO PCI手术作为标准治疗方法。
本综述旨在评估和描述CTO再通策略的最新进展。
