Xenogiannis Iosif, Varlamos Charalambos, Benetou Despoina-Rafailia, Alexopoulos Dimitrios
Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School Athens, Greece.
US Cardiol. 2021 May 27;15:e10. doi: 10.15420/usc.2020.37. eCollection 2021.
Chronic total occlusion (CTO) recanalization is among the most complex subsets of coronary interventions. Hence, optimum peri- and postprocedural anticoagulation and antiplatelet therapy is key for the achievement of successful revascularization and reduction of major adverse cardiovascular outcomes in patients undergoing CTO percutaneous coronary intervention (PCI). Unfractionated heparin is still considered the gold standard anticoagulant because its action can be reversed by protamine administration, with bivalirudin being reserved mainly for patients with heparin-induced thrombocytopenia. However, small studies comparing unfractionated heparin with bivalirudin in CTO interventions have shown similar outcomes. Glycoprotein IIb/IIIa inhibitors should, in general, be avoided. Aspirin in combination with clopidogrel for 6-12 months is the standard post CTO PCI dual antiplatelet regimen. For the most complex cases, clopidogrel can be substituted by a more potent P2Y inhibitor, namely ticagrelor or prasugrel.
慢性完全闭塞病变（CTO）再通是冠状动脉介入治疗中最复杂的亚组之一。因此，围手术期和术后最佳的抗凝及抗血小板治疗是成功实现血运重建以及降低接受CTO经皮冠状动脉介入治疗（PCI）患者主要不良心血管事件的关键。普通肝素仍被视为抗凝的金标准，因为其作用可通过使用鱼精蛋白来逆转，比伐卢定主要用于肝素诱导的血小板减少症患者。然而，在CTO介入治疗中比较普通肝素和比伐卢定的小型研究显示结果相似。一般应避免使用糖蛋白IIb/IIIa抑制剂。阿司匹林联合氯吡格雷使用6至12个月是CTO PCI术后的标准双联抗血小板方案。对于最复杂的病例，氯吡格雷可用更有效的P2Y抑制剂替格瑞洛或普拉格雷替代。
