慢性完全闭塞之个人观点

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1、PaulHsien-LiKao,MDAssistantProfessorNationalTaiwanUniversityMedicalSchool&HospitalChronicTotalOcclusionPersonalThoughtsLastfrontiersforPCIWiththeadvancementintechniquesandequipments,indicationsofpercutaneouscoronaryintervention(PCI)havebeenexpandedtoalm

2、ostallcomplexlesionsubsetsinallhighriskpatientspopulationsLeftmain(LM)coronaryarteryandchronictotalocclusion(CTO)remainthelastfrontiersforPCICTO:theAchillesheelofPCICTOisthemostchallenginglesionsubsetinPCISuccessrate50-70%Themostfrequentreasonoffailureis

3、unsuccessfulwirecrossingSuccessratedependsonthepatientselectioncriteria,equipmentavailability,aswellastheinterventionaltechniqueRestenosisrateafterCTOrecanalizationishigh50-70%afterballoononlySignificantre-stenosisandre-occlusionratesdespiteBMSWhyshouldw

4、eopenaCTO?ImprovesperfusiontoviabletissuewithischemiaImprovesperfusiontohibernationtissuewithdepressedcontractilefunctionProvideandincreasecollateralperfusiontootherviablemyocardialterritoryAvoidordeferCABG,makinglessinvasivehybridprocedurepossibleImprov

5、esclinicalsymptomsandlong-termsurvivalTOAST-GISESuccess(N=286)Failure(N=83)P-valueAlldeath3(1.0%)3(3.6%)0.13Cardiacdeath1(0.3%)3(3.6%)0.03Non-fatalQMI1(0.3%--Non-fatalNQMI1(0.3%)3(3.6%)0.03Cardiacdeath/MI3(1.0%)6(7.2%)0.005CABG7(2.4%)13(15.7%)<0.0001AnyT

6、LR33(11.5%)19(22.9)0.01AnyMACE35(12.2%)21(25.3)0.005376patients/390CTOattemptedin29Italiancentersfrom1999-2000Technicalsuccessrate77.3%Onlypredictorfor12monthMACEfreesurvivalissuccessofCTOPCIOlivarietat.JACC‘03DefinitionandindicationOcclusionInterruption

7、oflumenforacertaindistanceTIMI0orTIMI1(functionalocclusion)flowChronicNoACSwithin3months,ordocumented>3monthswithpriorangiogramCollaterals>Gr2shouldbepresentIndicationforPCIAnginaSilentorangina-equivalentsymptomswithischemiashowninnon-invasivestudiessuch

8、asthallium201scanEssentialsforCTOPCIBi-planecinewithgoodqualityfluoroscopySelectionsofdevices6-8FGCofvariouscurveMicro-catheter(personalfavoriteisExcelsior)CTOGW(personalfavoriteisConquestfamily)OTW1.25-1.5BCTornus,rotabla