Interventionelle Therapie chronischer Koronarverschlüsse

Abstract

Chronic total occlusions are occluded for at least 3 months with no signs of antegrade blood flow (TIMI 0 flow). Successful recanalization improves symptoms as well as left ventricular ejection fraction and prognosis of these patients. Cardiac magnetic resonance imaging is helpful to determine viable myocardium in the area of the occluded coronary artery. For antegrade techniques (parallel wire, seesaw technique, anchor wire, anchor balloon) retrograde angiography is important to visualize the target vessel distal of the occlusion. Antegrade techniques in combination with retrograde techniques (CART, reverse CART) allow high success rates up to 90%. Drug-eluting stents should be implanted in order to minimize the need for repeat revascularization.

Kernaussagen

• Chronische Koronarverschlüsse sind ein häufiger Befund einer Koronarangiographie. Vorhandene Kollateralen können unter Belastung eine ausreichende Perfusion nur selten aufrechthalten.

• Die Indikation zur Rekanalisation sollte gestellt werden, wenn es gilt, die Symptome zu lindern, die Ischämie zu verringern und die linksventrikuläre Pumpfunktion und Prognose zu verbessern.

• Eine kardiale Magnetresonanztomografie erlaubt die valide Beurteilung, ob vitales Myokard vorliegt.

• Die Rekanalisation setzt spezielle Techniken voraus, welche antegrad und retrograd zum Einsatz kommen. Eine sorgfältige Planung der Strategie mit Auswahl des Führungskatheters, Mikrokatheters und Wechsel der Führungsdrähte erhöht die Wahrscheinlichkeit auf Erfolg. Aufgrund der Komplexität und sehr guten Langzeitresultate sollten ausnahmslos DES neuerer Generation eingesetzt werden.

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