[1]马琛 陈少敏 崔鸣.冠状动脉慢性完全闭塞病变治疗研究进展[J].心血管病学进展,2020,(4):333-337.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.001]
　MA Chen,CHEN Shaomin,CUI Ming.Treatment in Patients with Coronary Chronic Total Occlusion[J].Advances in Cardiovascular Diseases,2020,(4):333-337.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.001]
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冠状动脉慢性完全闭塞病变治疗研究进展()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2020年4期
页码:
333-337
栏目:
综述
出版日期:
2020-04-25

文章信息/Info

Title:
Treatment in Patients with Coronary Chronic Total Occlusion
作者:
马琛1 陈少敏2 崔鸣2
(1.北京大学医学部第三临床医学院,北京 100191 ;2. 北京大学第三医院心内科,血管医学研究所,国家卫生健康委心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京 100191 )
Author(s):
MA Chen1;  CHEN Shaomin2;  CUI Ming2
(1.Third Clinical Medical SchoolPeking UniversityBeijing 100191 China; 2. Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China)
关键词:
冠状动脉慢性完全闭塞病变; 优化药物治疗; 经皮冠脉介入术; 冠状动脉旁路移植术
Keywords:
Chronic total occlusion;  Optimal medical therapy;  Percutaneous coronary intervention;  Coronary artery bypass graft
DOI:
10.16806/j.cnki.issn.1004-3934.2020.04.001
摘要:
冠状动脉慢性完全闭塞病变（chronic total occlusion，CTO）是临床中较为常见的严重冠状动脉病变。这些患者通常年龄更大，合并疾病更多。CTO病变的经皮冠脉介入术治疗难度较大，成功率相对低，且并发症的发生更多，但在经验丰富中心CTO病变经皮冠脉介入术的成功率已经达到80%~90%。CTO病变血运重建的获益目前还存在争议。观察性研究和注册研究显示，开通 CTO 病变可以缓解心绞痛症状，改善心功能，提高运动耐量，甚至可以减少心血管事件的发生，但是尚缺乏随机对照研究的支持。
Abstract:
Chronic coronary arterial total occlusion (CTO) is a common severe coronary artery disease in clinic. These patients are older and suffer from more concurrent diseases. It is difficult to treat CTO with percutaneous coronary intervention (PCI), with a low success rate and more complications. However, the success rate of PCI for CTO in experienced medical centers has reached 80% to 90%. Now there have been controversies over the benefit of revascularization in CTO. Observational studies and registry studies have shown that the opening of CTO can help relieve the symptoms of angina, improve the cardiac function, enhance exercise tolerance and even reduce cardiovascular events, which, however, lacks support from randomized controlled trials.

参考文献/References:


[1] Sianos G,Werner GS,Galassi AR,et al. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club[J]. EuroIntervention,2012,8(1):139-145.

[2] Christofferson RD,Lehmann KG,Martin GV,et al. Effect of chronic total coronary occlusion on treatment strategy[J]. Am J Cardiol,2005,95(9):1088-1091.

[3] Hoebers LP,Claessen BE,Elias J,et al. Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome[J]. Int J Cardiol,2015,187:90-96.

[4] Christakopoulos GE,Christopoulos G,Carlino M,et al. Metaanalysis of clinical outcomes of patients who underwent percutaneous coronary interventions for chronic total occlusions[J]. Am J Cardiol,2015,115:1367-1375.

[5] Ladwiniec A,Allgar V,Thackray S,et al. Medical therapy,percutaneous coronary intervention and prognosis in patients with chronic total occlusions[J]. Heart,2015,101(23):1907-1914.

[6] George S,Cockburn J,Clayton TC,et al. Long-term follow-up of elective chronic total coronary occlusion angioplasty:analysis from the U.K. Central Cardiac Audit Database[J]. J Am Coll Cardiol,2014,64(24):235-243.

[7] Wolff R,Fefer P,Knudtson ML,et al. Gender differences in the

prevalence and treatment of coronary chronic total occlusions[J].

Catheter Cardiovasc Interv,2016,87(6):1063-1070.

[8] Fefh P,Knudtson ML,Cheema AN,et al.current perspectives on coronay chronic total occlusions:the Canadian Multicenter Chmnic Total Occlusions Registry[J].J Am coll cardiol,2012,59(11):991,997.

[9] Hasegawa T,Godino C,Basavarajaiah S,et al. Differences in the clinical and angiographic characteristics of chronic total,occlusion lesions in the three major coronary arteries[J]. J I nterve Cardiol ,2014,27(1):44-49.

[10] McEntegart MB,Badar AA,Ahmad FA,et al.The collateral circulation of coronary chronic total occlusion[J].EuroIntervention,2016,11(14):e1596-1603.

[11] Christopoulos G,Karmpaliotis D,Alaswad K,et al. Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry[J]. Int J Cardiol,2015,198:222-228.

[12] Habara M,Tsuchikane E,Muramatsu T,et al. Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry[J]. Catheter Cardiovasc Interv,2016,87(6):1027-1035.

[13] Patel VG,Brayton KM,Tamayo A,et al. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18 061 patients from 65 studies[J]. JACC Cardiovasc Interv ,2013,6(2):128-136.

[14] Brilakis ES,Banerjee S,Karmpaliotis D,et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry) [J] . JACC Cardiovasc Interv,2015,8(2):245-253.

[15] Hannan EL,Zhong Y,Jacobs AK,et al. Patients with chronic total occlusions undergoing percutaneous coronary interventions: characteristics,success,and outcomes[J]. Circ Cardiovasc Interv,2016,9:e003586.

[16] Jones DA, Weerackody R , Rathod K , et al. Successful recanalization of chronic total occlusions is associated with improved long-term survival[J]. JACC Cardiovasc Interv ,2012,5(4):380-388.

[17] Mehran R,Claessen BE,Godino C,et al.Long-term outcome of percutaneous coronary intervention for chronic total occlusions[J].JACC Cardiovasc Interv,2011,4(9):952-961.

[18] Yamamoto E,Natsuaki M,Morimoto T,et al.Long-term outcomes after percutaneous coronary intervention for chronic total occlusion ( from the CREDO-Kyoto registry cohort-2) [J]. Am J Cardiol ,2013,112(6):767-774.

[19] Joyal D,Afilalo J,Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis [J]. Am Heart J ,2010,160(1):179-187.

[20] Karamasis GV,Kalogeropoulos AS,Mohdnazri SR,et al. Serial fractional flow reserve measurements post coronary chronic total occlusion percutaneous coronary intervention[J]. Circ Cardiovasc Interv,2018,11(11): e006941.

[21] Strauer BE,Brehm M,Zeus T,et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans [J]. Circulation ,2002,106(15):1913-1918.

[22] Schumacher SP,Driessen RS,Stuijfzand WJ,et al. Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non-occlusive lesions[J]. Catheter Cardiovasc Interv,2019,93(6):1059-1066.

[23] Hoebers LP,Claessen BE,Elias J,et al.Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome[J]. Int J Cardiol ,2015,187: 90-96.

[24] Rossello X,Pujadas S,Serra A,et al. Assessment of inducible myocardial ischemia,quality of life,and functional status after successful percutaneous revascularization in patients with chronic total coronary occlusion[J]. Am J Cardiol,2016,117(5):720-726.

[25] Mashayekhi K,Neuser H,Kraus A,et al. Successful percutaneous coronary intervention improves cardiopulmonary exercise capacity in patients with chronic total occlusions[J]. J Am Coll Cardiol,2017,69(8):1095-1096.

[26] Tomasello SD,Boukhris M,et al.Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions[J]. Eur Heart J,2015,36(45):3189-3198.

[27] Henriques JP,Hoebers LP,Ramunddal T,et al. EXPLORE Trial Investigators. Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: the EXPLORE trial [J]. J Am Coll Cardiol,2016,68(15):1622-1632.

[28] Park S. Drug-eluting stent implantation versus optimal medical treatment in patients with chronic total occlusion (DECISION-CTO) [J] . American College of Cardiology’s 66th Annual Scientific Session & Expo; Washington DC; 2017.

[29] Marui A ,Kimura T ,Nishiwaki N ,et al. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)[J]. Am J Cardiol,2015,115(8):1063-1072.

[30] Sachdeva R,Agrawal M,Flynn SE,et al. The myocardium supplied by a chronic total occlusion is a persistently ischemic zone[J]. Catheter Cardiovasc Interv,2014,83(1):9-16.

[31] Jang WJ,Yang JH,Choi SH,et al. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation[J]. JACC Cardiovasc Interv, 2015 ,8(2):271-279.

[32] Serruys PW,Morice MC,Kappetein AP,et al.Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease[J].N Engl J Med,2009,360(10) :961-972.

[33] Kim BS,Yang JH,Jang WJ,et al. Clinical outcomes of multiple chronic total occlusions in coronary arteries according to three therapeutic strategies:bypass surgery,percutaneous intervention and medication[J]. Int J Cardiol,2015,197:2-7.

[34] Farooq V,van Klaveren D,Steyerberg EW,et al.Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II[J].Lancet,2013,381(9867):639-650.

[35]?Green KD,Lynch DR Jr,Chen TP, et al. Combining PCI and CABG: the role of hybrid revascularization[J]. Curr Cardiol Rep ,2013,15(4):351.

[36]赵杰,吴永健,杨跃进,等.准分子激光冠状动脉成形术在慢性完全闭塞性病变中的应用[J].中国循环杂志,2017,3:222-226.

[37]Ambrosini V,Sorropago G,Laurenzano E,et al. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and ballo On-resistant coronary lesions: LEONARDO Study[J]. Cardiovasc Revasc Med,2015,16(3):141-146.

[38]Shen ZJ,García-García HM,Schultz C,et al. Crossing of a calcified "balloon uncrossable" coronary chronic total occlusion facilitated by a laser catheter: a case report and review recent four years’ experience at the thorax center[J]. Int J Cardiol,2010,145(2):251-254.

[39] 周鑫,闫红丹,唐梦熊,等.碎石血管成形—血管钙化新的治疗手段[J]. 心血管病学进展,2019,40(2):45-47.

[40] Hierlihy AM,Seale P,Lobe CG,et al. The postnatal heart contains a myocardial stem cell population[J]. FEBS Lett,2002,530(1-3):239-243.

[41] Chimenti I,Smith RR,Li TS,et al. Relative roles of direct regeneration versus paracrine effects of human cardiosphere-derived cells transplanted into infarcted mice[J]. Circ Res,2010,106(5):971-980.

[42] Bolli R ,Chugh AR,D’Amario D,et al. Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO): initial results of a randomised phase 1 trial[J]. Lancet,2011,378(9806): 1847-1857.

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备注/Memo

备注/Memo:
通讯作者：陈少敏,E-mail：chenshaomin1999@163.com
 
更新日期/Last Update: 2020-07-28