Ramanath Vijay S, Thompson Craig A
On behalf of the North American Total Occlusion (NATO) Operators.
Division of Cardiovascular Medicine, Yale University School of Medicine, Connecticut, US.
Interv Cardiol. 2013 Mar;8(1):41-45. doi: 10.15420/icr.2013.8.1.41.
Coronary chronic total occlusions (CTOs) are among the most challenging coronary artery lesions to treat percutaneously. In the last decade, great strides have been made to develop techniques to improve success rates. While success rates among high-volume operators are >90 %, non-CTO operators still continue to struggle with this lesion subset. Thus, efforts have been made to develop algorithms to help operators achieve successful recanalisation consistently and improve patient outcomes. The North American Total Occlusion (NATO) algorithm emphasises dual coronary injection using two guide catheters, which allows for switching from an antegrade to retrograde approach or vice versa should the initial strategy fail - the so-called 'hybrid' approach. Special attention is paid to four angiographic characteristics: 1) location of the proximal cap, 2) lesion length, 3) presence and suitability of collateral vessels for retrograde crossing and 4) location and quality of target vessel distal cap. The ultimate goal of this algorithm is to provide a strategy to achieve successful CTO revascularisation while using the least amount of fluoroscopy, contrast and equipment possible.
冠状动脉慢性完全闭塞病变（CTO）是经皮治疗最具挑战性的冠状动脉病变之一。在过去十年中，为开发提高成功率的技术取得了巨大进展。虽然高年资术者的成功率>90%，但非CTO术者在处理这类病变时仍面临困难。因此，人们努力开发算法，以帮助术者持续实现成功再通并改善患者预后。北美完全闭塞（NATO）算法强调使用两根引导导管进行双冠状动脉注射，这使得在初始策略失败时能够从正向方法转换为逆向方法，反之亦然——即所谓的“杂交”方法。特别关注四个血管造影特征：1）近端帽的位置，2）病变长度，3）用于逆向穿过的侧支血管的存在和适用性，以及4）靶血管远端帽的位置和质量。该算法的最终目标是提供一种策略，在使用尽可能少的透视、造影剂和设备的情况下实现成功的CTO血运重建。
