Muraca Iacopo, Carrabba Nazario, Virgili Giacomo, Bruscoli Filippo, Migliorini Angela, Pennesi Matteo, Pontecorboli Giulia, Marchionni Niccolò, Valenti Renato
Cardiovascular Department, Careggi University Hospital, Florence 50134, Italy.
World J Cardiol. 2022 Jan 26;14(1):13-28. doi: 10.4330/wjc.v14.i1.13.
Treatment of coronary chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has rapidly increased during the past decades. Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success. The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently, has led to an exponential increase in the number of CTO-PCI procedures, even if are still underutilized. It has been widely demonstrated that complete coronary revascularization, achieved by either coronary artery bypass graft or PCI, is associated with prognostic improvement, in terms of increased survival and reduction of major adverse cardiovascular events. The application of "contemporary" strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit, even in high-risk patients or complex coronary anatomy with CTO. The increasing success of CTO-PCI, allowing a complete or reasonable incomplete coronary revascularization, is enabling to overcome the last great challenge of interventional cardiology, adding a "complex" piece to "complete" the puzzle.
在过去几十年中，经皮冠状动脉介入治疗（PCI）用于治疗冠状动脉慢性完全闭塞（CTO）的情况迅速增加。近年来，人们开发了不同的策略和方法，使得CTO-PCI手术成功率有所提高。实现高完全率的广泛血运重建这一目标现在得到了强有力的科学证据支持，因此，即使CTO-PCI手术仍未得到充分利用，其手术数量也呈指数级增长。大量研究表明，通过冠状动脉旁路移植术或PCI实现的完全冠状动脉血运重建与预后改善相关，表现为生存率提高和主要不良心血管事件减少。应用旨在通过PCI实现最先进血运重建的“当代”策略，即使在高危患者或具有CTO的复杂冠状动脉解剖结构中，也能带来长期临床益处。CTO-PCI成功率不断提高，能够实现完全或合理的不完全冠状动脉血运重建，这使得介入心脏病学克服了最后一个巨大挑战，为“完整”拼图增添了一块“复杂”的部分。
