Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
J Cardiothorac Vasc Anesth. 2022 Jul;36(7):2132-2142. doi: 10.1053/j.jvca.2021.08.001. Epub 2021 Aug 8.
Advancing stent technology has enabled interventional cardiologists to perform percutaneous coronary intervention (PCI) to open chronic total occlusions (CTOs). Because PCI for CTOs improve patient anginal symptoms and quality of life, these procedures have been increasing over the past decade. Compared to standard PCI, these procedures are technically more difficult, with prolonged procedure time and increased risk of complications. Accordingly, anesthesiologists are increasingly being asked to provide sedation for these patients in the cardiac catheterization suite. In CTO PCI, anesthesiologists are more likely to encounter complications such as coronary artery perforation, malignant arrhythmias, non-target vessel ischemia, bleeding and shock. Additionally, CTO PCI may be supported by mechanical circulatory support devices. Understanding the procedural techniques of these complex PCI procedures is important to enable optimal anesthetic care in these patients. This narrative review discusses the pathophysiology, risks, benefits, procedural steps, and main anesthetic considerations for patients undergoing CTO PCI. Despite a growing body of literature, future research is still required to elucidate optimal anesthetic and mechanical support strategies in patients undergoing CTO PCI.
支架技术的进步使介入心脏病学家能够进行经皮冠状动脉介入治疗（PCI）以开通慢性完全闭塞（CTO）病变。由于 CTO 病变 PCI 可改善患者心绞痛症状和生活质量，因此在过去十年中，这些手术的数量一直在增加。与标准 PCI 相比，这些手术在技术上更具挑战性，手术时间延长，并发症风险增加。因此，越来越多的麻醉师被要求在心脏导管室为这些患者提供镇静。在 CTO PCI 中，麻醉师更有可能遇到冠状动脉穿孔、恶性心律失常、非靶血管缺血、出血和休克等并发症。此外，CTO PCI 可能需要机械循环支持装置的支持。了解这些复杂 PCI 手术的手术技术对于为这些患者提供最佳麻醉护理非常重要。本文综述讨论了接受 CTO PCI 患者的病理生理学、风险、益处、手术步骤和主要麻醉注意事项。尽管文献数量不断增加，但仍需要进一步研究以阐明接受 CTO PCI 患者的最佳麻醉和机械支持策略。
