慢性完全性閉塞（Chronic Total Occlusion, CTO）作為冠狀動(dòng)脈慢性閉塞病變的一種，通常意義上閉塞時(shí)間會(huì)超過(guò)三個(gè)月。CTO病變目前接受皮冠狀動(dòng)脈介入術(shù)(Percutaneous Coronary Intervention, PCI)者少于8%，只占PCI全部病例的10%~20%【1,2】。尤其對(duì)于病變時(shí)間長(zhǎng)或病變段較長(zhǎng)的患者治療，如何成功地開(kāi)通血管并在長(zhǎng)期內(nèi)保持較好的效果存在很多問(wèn)題。PCI在近30年內(nèi)隨著介入制造工藝水平和手術(shù)器械涉及的提高、一些輔助設(shè)備的出現(xiàn)完善和相關(guān)藥物治療的進(jìn)展取得了大踏步的前進(jìn)。手術(shù)成功率的提高，使更多的患者開(kāi)始接受這種曾經(jīng)相對(duì)危險(xiǎn)的治療方法，但CTO病變治療仍然是心內(nèi)科介入醫(yī)生面臨的挑戰(zhàn)之一。

1. CTO的定義、分類及病理

學(xué)術(shù)界關(guān)于CTO的定義有很多說(shuō)法，，至今尚未統(tǒng)一。在本研究中，根據(jù)ACC的最新定義，將CTO特指為閉塞時(shí)間超過(guò)三個(gè)月的病變【3】。同時(shí)，根據(jù)是否有前向血流的存在，進(jìn)一步將慢性完全閉塞病變分為慢性完全性閉塞（前向血流TIMI 0級(jí)）和慢性功能性閉塞（前向血流TIMI 1級(jí)）【4】。作為動(dòng)脈粥樣硬化病變發(fā)展為嚴(yán)重狹窄病變的最終階段，CTO病變?cè)陟o息狀態(tài)下的心肌需氧量相對(duì)比較少，如果有側(cè)枝循環(huán)的建立，那么患者可以維持心肌存貨，但是如果體力活動(dòng)增加或者情緒有強(qiáng)烈波動(dòng)則會(huì)因?yàn)椴荒茉黾庸┭醵霈F(xiàn)心絞痛等現(xiàn)象，使患者的生活水平下降，生命也受到危險(xiǎn)。因此，通過(guò)指引導(dǎo)絲通過(guò)新生微通道可以提高運(yùn)動(dòng)耐量從而有效改善患者的狀況。

2. CTO的組織病理學(xué)、臨床表現(xiàn)及臨床意義
2.1 組織病理學(xué)
2.2 臨床表現(xiàn)
2.3 臨床意義
3. CTO病變血運(yùn)重建的理論基礎(chǔ)
3.1 閉塞部位存在存活心肌
3.2 抑制左室重構(gòu)
4. CTO再灌注介入治療
4.1 再灌注策略
4.2 器械選擇
4.3 影響手術(shù)成功的因素
5. CTO病變治療中一些新技術(shù)和器械的研究進(jìn)展與展望
5.1 Frontrunner導(dǎo)管
5.2 內(nèi)膜下尋蹤及再入STAR技術(shù) 
5.3 平行指引導(dǎo)絲技術(shù)和蹺板指引導(dǎo)絲技術(shù)
5.4 逆向?qū)б摻z對(duì)吻技術(shù)
5.5 CART
5.6 導(dǎo)絲捕獲技術(shù)
5.7 超聲治療Crosser系統(tǒng)
5.8 斑塊消化
5.9 PCI聯(lián)合干細(xì)胞移植
5.10 準(zhǔn)分子激光導(dǎo)管
5.11 磁導(dǎo)航導(dǎo)操作系統(tǒng)
6．    降低CTO患者術(shù)后再狹窄率的研究進(jìn)展以及患者的預(yù)后
6.1 CTO病變治療中支架應(yīng)用
6.2藥物洗脫支架治療CTO進(jìn)展
6.3個(gè)人介入技術(shù)

綜上所述，在冠脈介入治療中，CTO始終是最大的挑戰(zhàn)，雖然還有很多的缺陷和不足，但是隨著器械的研究改進(jìn)、醫(yī)者的經(jīng)驗(yàn)增加，手術(shù)成功率可以得到一步步的提高。這些臨床經(jīng)驗(yàn)的增加和科學(xué)研究的進(jìn)步將為患者的長(zhǎng)遠(yuǎn)受益將有極大幫助，醫(yī)者對(duì)病變本身也會(huì)有更深刻的認(rèn)識(shí)。
 

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