Synetos Andreas, Koliastasis Leonidas, Ktenopoulos Nikolaos, Katsaros Odysseas, Vlasopoulou Konstantina, Drakopoulou Maria, Apostolos Anastasios, Tsalamandris Soritios, Latsios George, Toutouzas Konstantinos, Patrikios Ioannis, Tsioufis Constantinos
School of Medicine, European University of Cyprus, 2404 Egkomi, Cyprus.
First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece.
J Clin Med. 2025 Feb 25;14(5):1535. doi: 10.3390/jcm14051535.
Coronary chronic total occlusions (CTOs) have been a point of interest of the medical community for the last decade. The natural history of CTOs was for a long time unknown, as the presence of a single CTO was the most frequent cause for the exclusion of patients from randomized controlled trials (RCTs). Recent CTO RCTs have failed to show any benefit in terms of hard endpoints as major adverse cardiovascular events, but have shown a significant improvement in quality of life, as well in the frequency of angina; however, these studies are characterized by the limitation of the short duration of their follow-up period. Real-world data from observational studies indicate a significant improvement in cardiovascular death and overall mortality, suggesting that the results depend on the duration of the follow-up, and not on the procedure per se. The aim of the current review is to summarize all the existing RCTs, and to analyze the most important registries, as well as to present the current development of techniques to boost the successful interventional treatment of CTOs.
在过去十年中，冠状动脉慢性完全闭塞（CTO）一直是医学界关注的焦点。长期以来，CTO的自然病史并不为人所知，因为单个CTO的存在是患者被排除在随机对照试验（RCT）之外的最常见原因。近期的CTO-RCT在主要不良心血管事件等硬终点方面未能显示出任何益处，但在生活质量以及心绞痛发作频率方面有显著改善；然而，这些研究的特点是随访期较短。观察性研究的真实世界数据表明心血管死亡和总体死亡率有显著改善，这表明结果取决于随访时间，而非手术本身。本综述的目的是总结所有现有的RCT，并分析最重要的登记数据，同时介绍当前促进CTO成功介入治疗的技术发展情况。
