Cosgrove Claudia, Mahadevan Kalaivani, Spratt James C, McEntegart Margaret
St George's University Hospitals NHS Foundation Trust London, UK.
Bristol Heart Institute Bristol, UK.
Interv Cardiol. 2021 Oct 20;16:e30. doi: 10.15420/icr.2021.01. eCollection 2021 Apr.
Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.
冠状动脉钙化在慢性完全闭塞病变（CTO）中普遍存在，尤其是在病程较长以及冠状动脉旁路移植术后的患者中。钙化的存在预示着CTO经皮冠状动脉介入治疗的手术成功率较低且并发症风险较高。辅助成像，包括术前计算机断层扫描和冠状动脉内成像，有助于了解钙化的分布和形态。需要使用专门的导丝和微导管，以及穿透、内膜下进入和管腔重新进入技术来穿过钙化的CTO。在CTO经皮冠状动脉介入治疗期间，已报道使用旋切装置和基于球囊的钙化修饰工具，尽管它们受到对内膜下空间安全性和有效性担忧的限制。
