Chronischer Koronarverschluss: Neue Techniken und Strategien

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Zusammenfassung

In dieser Übersicht werden die gegenwärtigen und künftigen Strategien in der Behandlung eines chronischen Koronarverschlusses (CTO) vorgestellt und diskutiert. Die anerkannte Indikation für die Revaskularisation sind das Vorhandensein typischer Beschwerden, der Nachweis von viablem Myokard bei Patienten mit einem vorausgegangenen Myokardinfarkt und prognostische Überlegungen vor allem bei Patienten mit Mehrgefäßerkrankungen. Die überwiegende Mehrheit der Patienten mit CTO erfüllen diese Kriterien, werden aber gegenwärtig dennoch nicht in der erwarteten Häufigkeit interventionell behandelt.

In diesem Beitrag werden die Grundregeln für die Anwendung der neuen Drahttechniken zur interventionellen Revaskularisation und Weiterentwicklungen vorgestellt. Diese sollten breitere Anwendung finden, um eine höhere Interventionserfolgsrate auch in weniger erfahrenen Zentren zu erzielen, während die weiter fortentwickelten Ansätze einschließlich der retrograden Rekanalisationstechnik wenigen spezialisierten Institutionen vorbehalten sein sollten. Trotz dieser aggressiveren Ansätze zur Passage eines verschlossenen Gefäßes ist die Komplikationsrate nicht höher als bei nichtokklusiven Läsionen, wenn die spezifischen Komplikationen der Rekanalisation durch sorgfältige Vorgehensweise vermieden werden.

Schlüsselwörter

Chronischer Koronarverschluss Koronarintervention Indikation Technik Prognose 

Chronic total coronary occlusion: New techniques and treatment strategies

Abstract

This paper presents an overview of the current and future strategies for the treatment approach of chronic total coronary occlusions (CTOs). The established indications for revascularization are the presence of symptoms, detection of viable myocardium in patients with a previous acute myocardial infarction, and prognostic considerations especially in patients with multi-vessel disease. The vast majority of patients with a CTO fulfill these criteria but still seem to be considerably undertreated in current PCI practice.

The basic rules of applying the new wire techniques and the advancements are presented, which should be adopted more widely and would lead to an improvement of the procedural success rate also in nonspecialized centers, whereas the most advanced approaches such as the retrograde wiring and lesion recanalization may remain reserved for dedicated centers. Despite more aggressive approaches, the complication rate can be limited to that of nonocclusive lesions. However, awareness of the specific causes of complications in CTOs is warranted.

Key words

chronic total coronary occlusion percutaneous coronary intervention indication technique prognosis 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Medizinische Klinik I, Kardiologie & IntensivmedzinKlinikum DarmstadtDarmstadtGermany

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