Wu Eugene B, Matsuno Shunsuke, Nagamatsu Wataru, Kalyanasundaram Arun, Harding Scott A, Lo Sidney, Lim Soo Teik, Ge Lei, Chen Ji-Yan, Luo Henry J F, Quan Jie, Lee Seung-Whan, Kao Hsien-Li, Tsuchikane Etsuo
Prince of Wales Hospital, Hong Kong.
The Cardiovascular Institute, Tokyo, Japan.
JACC Asia. 2025 Feb;5(2):219-230. doi: 10.1016/j.jacasi.2024.12.009. Epub 2025 Feb 4.
Antegrade wiring (AW) is the prevailing chronic total occlusion (CTO) crossing technique. For proximal cap ambiguity, the Global CTO consensus group uses the "anatomy dictates strategy" method: 1) intravascular ultrasound; 2) move the cap; or 3) retrograde. For CTO body crossing, anatomy dictates 4 strategies: 1) CTOs with tapered stump-loose tissue tracking; 2) CTOs with clear intimal path-intentional intimal tracking with 3-dimensional (3D) wiring; 3) CTOs without a clear intimal path-intentional intimal tracking with intermediate penetration wire; and 4) the "long plus CTOs"-intentional subintimal wiring. The new angiographic 3D antegrade puncture technique from the APCTO (Asia Pacific Chronic Total Occlusion) Club is presented for distal cap puncture. angiographic 3D antegrade puncture technique can be used as a 3D wiring technique as well as an antegrade dissection and re-entry technique. Based on these new frontiers, we have updated our APCTO algorithm in this paper. This update can form a basis for research and training.
正向导丝技术（AW）是目前治疗慢性完全闭塞病变（CTO）的主要技术。对于近端纤维帽不明确的情况，全球CTO共识小组采用“解剖结构决定策略”的方法：1）血管内超声；2）移动纤维帽；或3）逆向技术。对于CTO病变主体的通过，解剖结构决定了4种策略：1）残端呈锥形的CTO病变——疏松组织追踪；2）内膜路径清晰的CTO病变——采用三维（3D）导丝技术进行有意的内膜追踪；3）内膜路径不清晰的CTO病变——采用中等穿透力导丝进行有意的内膜追踪；4）“长段CTO病变”——有意进行内膜下导丝技术。亚太CTO俱乐部（APCTO）提出了一种用于远端纤维帽穿刺的新型血管造影三维正向穿刺技术。血管造影三维正向穿刺技术既可以用作三维导丝技术，也可以用作正向夹层和再入技术。基于这些新进展，我们在本文中更新了我们的APCTO算法。这一更新可为研究和培训奠定基础。
