Retrograde approach for revascularization of a coronary chronic total occlusion with review of literature.

摘要

Not every coronary occlusion results in an acute coronary syndrome (ACS). The occlusion can develop gradually, allowing collateral circulation formation. If this circulation does not suffice, ischaemia in the under-perfused myocardial region will cause angina during exercise or progressive symptoms of heart failure. Chronic total occlusion (CTO) of a coronary artery is defined as a complete occlusion (TIMI grade 0 flow) for 3 months or longer. Such occlusions differ from 'recent' occlusions (>= 3 days) due to an ACS. In this situation, late revascularization has not proven to be superior to optimal medical treatment in the recent TOSCA-2 trial and OAT-trial. Generally, in an ACS there is no or little collateral circulation and after more than 3 days, the regional myocardial viability is lost, which makes a percutaneous coronary intervervention (PCI) useless at that time.