经皮冠状动脉介入治疗冠状动脉慢性完全闭塞病变面临的思考与挑战

Critical Thinking and Challenges of Percutaneous Coronary Intervention for Chronic Total Occlusive Lesions of the Coronary Arteries

伴随着器械、技术的进步以及冠状动脉慢性完全闭塞(CTO)病变介入理论的更新,CTO病变开通成功率升高,但CTO病变依然是冠状动脉介入领域的难点及热点之一。目前研究对于经皮冠状动脉介入治疗(PCI)能否减少患者主要不良心血管事件(MACE)尚无定论。近年来,中国医学科学院阜外医院一项纳入2659例CTO病变患者的研究显示,高质量的开通与CTO病变患者MACE的减少相关。基于此,哪些人群更需要开通CTO病变或者从CTO病变开通中获益是目前面临的问题,如何高质量地开通CTO病变以及在无法完成高质量开通后的处理策略是临床医师面临的挑战。目前内膜下路径提高了CTO病变开通成功率,介入无置入以及内膜下斑块修饰的理念也在不断涌现。

With significant advances in devices,techniques and updated theories,the success rate of opening chronic total occlusion(CTO)by percutaneous coronary intervention(PCI)has increased,but CTO remains one of the most challenging and hot issues in the field of coronary interventions.Current research is inconclusive as to whether PCI can reduce major adverse cardiovascular event(MACE)in CTO patients.In recent years,it has been suggested that high-quality revascularization is associated with a reduction in adverse cardiovascular events in patients with CTO.Based on this,the question of which populations are more likely to require or benefit from CTO opening is currently under consideration,and the challenge is how to achieve high quality opening and what the management strategy should be considered if high quality opening is not possible.Currently,the application of subendothelial PCI route has improved the success rate of CTO opening,and the concept of intervention without implantation and subendothelial plaque modification has emerged in this field.This article summarized above advances.