Die chronische Koronarokklusion

Zusammenfassung

Die Wiedereröffnung chronischer Koronarokklusionen unterscheidet sich maßgeblich von der Koronarangioplastie stenosierter Gefäße und gilt als die größte interventionelle Herausforderung. Das Verfahren hat sich in den letzten 10 Jahren sehr entwickelt und verfeinert und in den Händen Geübter zu einer Steigerung der Erfolgsrate von etwa 60 % auf über 90 % geführt. Durch Einsatz medikamentenbeschichteter Stents wird heute eine Offenrate von ebenfalls über 90 % erzielt Diese Ergebnisse sind denen der Bypassoperation ebenbürtig oder gar überlegen. In der vorliegenden Arbeit werden einige für die CTO-PCI speziell entwickelte Techniken beschrieben und es wird unterstrichen, dass eine gezielte Anleitung und kontinuierliches Training notwendig ist, um die in den Leitlinien der ESC/EACTS geforderte Erfolgsrate von mindestens 80 % zu erreichen und sicherzustellen, dass Patienten, die eine Revaskularisation benötigen, diese nicht vorenthalten wird.

Abstract

Percutaneous coronary intervention for chronic total occlusions markedly differs from PCI of stenotic lesions and is considered the most difficult and time consuming intervention. The procedure is evolving rapidly, well documented by a success rate that increased in the hands of specifically trained operators from about 60 % to over 90 % in the past 10 years, the long-term patency with drug eluting stents exceeding 90 %. These results are comparable or even superior to surgical revascularisation. Several sophisticated techniques unique to CTO interventions are described and the need for specific training is emphasised so that the success rate of at least 80 % as claimed by the ESC guidelines on myocardial revascularisation can be met and patients with CTO who deserve revascularisation are no longer denied appropriate treatment.

Schlüsselwörter

chronische Koronarokklusion - interventionelle Therapie - Paralleldrahttechnik - retrogrades Vorgehen

Key words

chronic coronary occlusion - interventional therapy - parallel wire technique - retrograde approach

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