Walsh Simon J, Cosgrove Claudia, Spratt James C, Hanratty Colm G
Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, United Kingdom.
St George's University Hospital, London, United Kingdom.
Korean Circ J. 2019 Jul;49(7):559-567. doi: 10.4070/kcj.2019.0160.
Coronary chronic total occlusions (CTOs) are a commonly encountered lesion. These present in a diverse patient population with variable anatomy. Technical success rates of ~90% are achievable for CTO lesions in centers with appropriate expertise. Many lesions can be crossed with wire-based techniques. However, the most anatomically complex and technically challenging lesions will often require more advanced approaches such as retrograde access and/or the application of blunt dissection techniques in the vessel to safely navigate long and/or ambiguous CTO segments. Retrograde dissection and re-entry (RDR) and antegrade dissection and re-entry (ADR) strategies are often needed to treat such lesions. In many circumstances, ADR offers a safe and efficient means to successfully cross a CTO lesion. Therefore, operators must remain cognizant of the risks and benefits of differing technical approaches during CTO percutaneous coronary intervention, particularly when both ADR and RDR are feasible. This article provides an overview of the ADR technique in addition to updated approaches in contemporary clinical practice.
冠状动脉慢性完全闭塞（CTO）是一种常见病变。这些病变出现在解剖结构各异的不同患者群体中。在具备适当专业知识的中心，CTO病变的技术成功率可达约90%。许多病变可以通过基于导丝的技术穿过。然而，解剖结构最复杂、技术难度最大的病变通常需要更先进的方法，如逆向入路和/或在血管中应用钝性分离技术，以安全通过长段和/或不明确的CTO节段。治疗此类病变通常需要逆向分离和再入路（RDR）和顺向分离和再入路（ADR）策略。在许多情况下，ADR为成功穿过CTO病变提供了一种安全有效的方法。因此，在CTO经皮冠状动脉介入治疗期间，术者必须始终认识到不同技术方法的风险和益处，尤其是当ADR和RDR均可行时。本文除了介绍当代临床实践中的更新方法外，还概述了ADR技术。
