Berkhout T, Claessen B E, Dirksen M T
Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
Neth Heart J. 2021 Jan;29(1):52-59. doi: 10.1007/s12471-020-01509-8. Epub 2020 Nov 6.
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is considered relatively complex with low success rates and high complication rates. Treating a CTO with PCI using the hybrid algorithm increases success rates with acceptable complication rates. An essential part of the hybrid algorithm is antegrade dissection and reentry (ADR). In PCI of a non-CTO coronary lesion, the guidewire over which the stent is advanced and placed stays within the true lumen of the coronary artery. ADR techniques make it possible to cross the lesion through the wall of the coronary artery, the subintimal space, thus creating a small bypass within the architecture of the coronary artery and restoring antegrade blood flow. ADR increases success rates, especially in more difficult CTO procedures. In the last decade, new materials and techniques have been introduced in quick succession, which are summarised in this review. Consequently an updated ADR algorithm is presented, which can support the CTO operator during an ADR procedure.
经皮冠状动脉介入治疗（PCI）慢性完全闭塞病变（CTO）被认为相对复杂，成功率低且并发症发生率高。使用混合算法通过PCI治疗CTO可提高成功率并使并发症发生率在可接受范围内。混合算法的一个重要部分是正向夹层分离和再入（ADR）。在非CTO冠状动脉病变的PCI中，推进并放置支架所使用的导丝会留在冠状动脉的真腔内。ADR技术使穿过冠状动脉壁、内膜下间隙的病变成为可能，从而在冠状动脉结构内形成一个小的旁路并恢复正向血流。ADR可提高成功率，尤其是在更困难的CTO手术中。在过去十年中，新材料和技术相继推出，本综述对此进行了总结。因此，本文提出了一种更新的ADR算法，可在ADR手术期间为CTO手术操作者提供支持。
