El Shafey Wassam El Din Hadad
Cardiology Department, Faculty of Medicine, Menoufiya University, Shebin El Koom, Egypt.
Egypt Heart J. 2017 Jun;69(2):161-163. doi: 10.1016/j.ehj.2016.10.002. Epub 2016 Dec 18.
Chronic total occlusion (CTO) is probably caused by thrombus and lipid-rich cholesterol esters that are replaced over time by collagen and calcium deposition. Experimental models showed endothelial cell necrosis in response to vessel ligation, whereas more recent models suggest that the endothelium might retain viability guiding the subsequent development of CTO, including CTO neo-revascularization, which occurs within the lumen and in various layers of the vessel wall, by the release of paracrine substances. It is uncertain whether after CTO recanalization the recovery of anterograde reverses endothelial dysfunction, thus promoting vasodilation and positive remodeling.
慢性完全闭塞（CTO）可能由血栓和富含脂质的胆固醇酯引起，随着时间的推移，这些物质会被胶原蛋白和钙沉积所取代。实验模型显示，血管结扎会导致内皮细胞坏死，而最近的模型表明，内皮细胞可能保持活力，通过旁分泌物质的释放引导CTO的后续发展，包括CTO新生血管形成，其发生在管腔和血管壁的各层中。目前尚不确定CTO再通后顺行血流的恢复是否会逆转内皮功能障碍，从而促进血管舒张和正向重塑。
