Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow cha...Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow characteristics.In“true”CTO,there is no anterograde flow.In“functional”CTO,there is minimal anterograde flow through the occluded segment of the coronary artery.CTO is a common fi nding during coronary angiography and its prevalence may vary depending on the reported literature.Among patients without previous coronary artery bypass grafting(CABG),CTO is found in about 20–30% of the patients.CTO may develop insidiously over a period of time and involve a complex interplay between intracellular and extracellular factors,smooth muscle and foam cells,calcifi cation,and neovascularization.There is a growing body of evidence to support that CTO revascularization may improve clinical outcome when compared to medical management.Both the European and American cardiovascular societies support CTO revascularization with a class 2a recommendation(level of evidence B).Historically,due to low procedural success rate,apparent ineffi cient resource utilization,potential increase in complication rates and uncertain clinical benefi ts,only about 10–20%of patients with CTO are treated with percutaneous coronary intervention(PCI).Recent advances using novel and innovative techniques with dedicated equipment have signifi cantly improved the procedural success rate for CTO PCI to about 90%in the hands of experienced operators.With increasing interest in CTO PCI coupled with increased educational effort,CTO PCI likely will become more accessible to patients in need of CTO revascularization.Ongoing advancement in innovative techniques and equipment will continue to improve procedural success rates and reduce procedural complication rate for CTO PCI.Furthermore,there are a number of prospective clinical trials on the horizon which should help defi ne the clinical benefi ts and limitations of CTO PCI in the near future.展开更多
Introduction Chronic total occlusion(CTO),is a common abnor-mality in patients with known coronary artery dis-ease.Many of these patients have been undertreated because of the poor prognosis associated with other know...Introduction Chronic total occlusion(CTO),is a common abnor-mality in patients with known coronary artery dis-ease.Many of these patients have been undertreated because of the poor prognosis associated with other known coronary artery disease;e.g.,multivessel CAD(MVCAD).展开更多
文摘Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow characteristics.In“true”CTO,there is no anterograde flow.In“functional”CTO,there is minimal anterograde flow through the occluded segment of the coronary artery.CTO is a common fi nding during coronary angiography and its prevalence may vary depending on the reported literature.Among patients without previous coronary artery bypass grafting(CABG),CTO is found in about 20–30% of the patients.CTO may develop insidiously over a period of time and involve a complex interplay between intracellular and extracellular factors,smooth muscle and foam cells,calcifi cation,and neovascularization.There is a growing body of evidence to support that CTO revascularization may improve clinical outcome when compared to medical management.Both the European and American cardiovascular societies support CTO revascularization with a class 2a recommendation(level of evidence B).Historically,due to low procedural success rate,apparent ineffi cient resource utilization,potential increase in complication rates and uncertain clinical benefi ts,only about 10–20%of patients with CTO are treated with percutaneous coronary intervention(PCI).Recent advances using novel and innovative techniques with dedicated equipment have signifi cantly improved the procedural success rate for CTO PCI to about 90%in the hands of experienced operators.With increasing interest in CTO PCI coupled with increased educational effort,CTO PCI likely will become more accessible to patients in need of CTO revascularization.Ongoing advancement in innovative techniques and equipment will continue to improve procedural success rates and reduce procedural complication rate for CTO PCI.Furthermore,there are a number of prospective clinical trials on the horizon which should help defi ne the clinical benefi ts and limitations of CTO PCI in the near future.
文摘Introduction Chronic total occlusion(CTO),is a common abnor-mality in patients with known coronary artery dis-ease.Many of these patients have been undertreated because of the poor prognosis associated with other known coronary artery disease;e.g.,multivessel CAD(MVCAD).
