Download PDF
Kardiologie up2date 2014; 10(04): 259-268
DOI: 10.1055/s-0034-1391215
Koronare Herzerkrankung und Atheroskerose
© Georg Thieme Verlag KG Stuttgart · New York

Der chronische Koronarverschluss

Sinisa Markovic
,
Jochen Wöhrle
Further Information

Publication History

Publication Date:
21 January 2015 (online)

Also available at
    Permissions and Reprints All articles of this category

Abstract

Chronic coronary occlusions are a frequent finding in coronary angiography. Existing collaterals can rarely maintain sufficient perfusion during exercise, so that patients with viable myocardium suffer typical angina due to ischemia.

Aim of a recanalization of a chronic target occlusion is to reduce the symptoms and ischemia and to improve left ventricular function. Successful recanalisation may improve the long-term outcome of the patient. A cardiac MRI can determine myocardial viability and should be performed prior to percutaneous coronary intervention of a chronic target occlusion. The recanalization of chronic occluded vessels requires special techniques, including an antegrade and or retrograde approach. A careful procedure planning combined with a thoughtful selection of the guiding catheter, microcatheter and exchange guidewires will increase the chances for success. For the long-term result modern drug-eluting stents should be used exclusively.

Kernaussagen

  • Der chronische Koronarverschluss definiert sich über die Dauer des Verschlusses (mindestens 3 Monate) und eine fehlende antegrade Kontrastmittelfüllung (TIMI 0).

  • Die Indikation zur Rekanalisation eines chronischen Koronarverschlusses sollte auf der Basis von pektanginösen Beschwerden oder dem Nachweis einer Koronarischämie gestellt werden. Eine kardiale MRT erlaubt die valide Beurteilung, ob vitales Myokard vorliegt.

  • Die Rekanalisation setzt spezielle Techniken voraus und fordert eine sorgfältige Planung der Strategie mit Auswahl des Führungskatheters, Mikrokatheters und der Führungsdrähte.

 

  • Literatur

  • 1 Christofferson RD, Lehmann KG, Martin GV et al. Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 2005; 95: 1088-1091
    Google Scholar
  • 2 Sianos G, Werner GS, Galassi AR et al. EuroCTO Club. Recanalisation of Chronic Total coronary Occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 2012; 8: 139-145
    CrossrefPubMedGoogle Scholar
  • 3 Grantham JA, Marso SP, Spertus J et al. Chronic total occlusion angioplasty in the United States. J Am Coll Cardiol Intv 2009; 2: 479-486
    CrossrefPubMedGoogle Scholar
  • 4 Grantham JA, Jones PG, Cannon L et al. Quantifying the early health status benefits of successful chronic total occlusion recanalization: results from the FlowCardia’s Approach to Chronic Total Occlusion recanalization (FACTOR) trial. Circ Cardiovasc Qual Outcomes 2013; 3: 284-290
    PubMedGoogle Scholar
  • 5 Olivari Z, Rubartelli P, Piscione F et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multi-center, retrospective, observational study (TOAST-GISE). J Am Coll Cardiol 2003; 41: 1672-1678
    CrossrefPubMedGoogle Scholar
  • 6 Wöhrle J, Chadid P, Markovic S et al. Changes in left ventricular function and wall motion determined by cardiac magnetic resonance imaging after successful recanalization of true chronic total occlusion in native coronary arteries. DGK; Mannheim: 2013
    Google Scholar
  • 7 Pujadas S, Martin V, Rosselló X et al. Improvement of myocardial function and perfusion after successful percutaneous revascularization in patients with chronic total coronary occlusion. Int J Cardiol 2013; 169: 147-152
    CrossrefPubMedGoogle Scholar
  • 8 Kirschbaum SW, Baks T, van den Ent M et al. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total occlusions. Am J Cardiol 2008; 101: 179-185
    CrossrefPubMedGoogle Scholar
  • 9 Cheng AS, Selvanayagam JB, Jerosch-Herold M et al. Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility: insights from quantitative cardiovascular magnetic resonance imaging. JACC Cardiovasc Interv 2008; 1: 44-53
    CrossrefPubMedGoogle Scholar
  • 10 Pancholy 1 SB, Boruah P, Ahmed I et al. Meta-analysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy. Am J Cardiol 2013; 111: 521-525
    CrossrefPubMedGoogle Scholar
  • 11 George S, Cockburn J, Clayton TC et al. British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. J Am Coll Cardiol 2014; 64: 235-243
    CrossrefPubMedGoogle Scholar
  • 12 Suero JA, Marso SP, Jones PG et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 2001; 38: 409-414
    CrossrefPubMedGoogle Scholar
  • 13 Hoye A, van Domburg RT, Sonnenschein K et al. Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992–2002. Eur Heart J 2005; 26: 2630-2636
    CrossrefPubMedGoogle Scholar
  • 14 Werner GS, Surber R, Ferrari M et al. The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction. Eur Heart J 2006; 27: 2406-2412
    CrossrefPubMedGoogle Scholar
  • 15 Chung CM, Nakamura S, Tanaka K et al. Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction. Catheter Cardiovasc Interv 2003; 60: 368-374
    CrossrefPubMedGoogle Scholar
  • 16 Sirnes PA, Myreng Y, Mølstad P et al. Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions. Eur Heart J 1998; 19: 273-281
    CrossrefPubMedGoogle Scholar
  • 17 Werner GS, Emig U, Bahrmann P et al. Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion. Heart 2004; 90: 1303-1309
    CrossrefPubMedGoogle Scholar
  • 18 Nakamura S, Muthusamy TS, Bae JH et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions. Am J Cardiol 2005; 95: 161-166
    CrossrefPubMedGoogle Scholar
  • 19 Hombach V, Grebe O, Merkle N et al. Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imaging. Eur Heart J 2005; 26: 549-557
    PubMedGoogle Scholar
  • 20 Baks T, van Geuns RJ, Duncker DJ et al. Prediction of left ventricular function after drug-eluting stent implantation for chronic total coronary occlusions. J Am Coll Cardiol 2006; 47: 721-725
    CrossrefPubMedGoogle Scholar
  • 21 Kirschbaum SW, Baks T, van den Ent M et al. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol 2008; 101: 179-185
    CrossrefPubMedGoogle Scholar
  • 22 Werner GS, Diedrich J, Scholz KH et al. Vessel reconstruction in total coronary occlusions with a long subintimal wire pathway: use of multiple stents under guidance of intravascular ultrasound. Cathet Cardiovasc Diagn 1997; 40: 46-51
    CrossrefPubMedGoogle Scholar
  • 23 Rathore S, Terashima M, Suzuki T. Value of intravascular ultrasound in the management of coronary chronic total occlusions. Catheter Cardiovasc Interv 2009; 4: 873-878
    PubMedGoogle Scholar
  • 24 Colmenarez HJ, Escaned J, Fernández C et al. Efficacy and safety of drug-eluting stents in chronic total coronary occlusion recanalization: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55: 1854-1866
    CrossrefPubMedGoogle Scholar
  • 25 De Felice 1 F, Fiorilli R, Parma A et al. 3-year clinical outcome of patients with chronic total occlusion treated with drug-eluting stents. JACC Cardiovasc Interv 2009; 2: 1260-1265
    CrossrefPubMedGoogle Scholar
  • 26 Saeed B, Kandzari DE, Agostoni P et al. Use of drug-eluting stents for chronic total occlusions: a systematic review and meta-analysis. Catheter Cardiovasc Interv 2011; 77: 315-332
    CrossrefPubMedGoogle Scholar
  • 27 Jang J, Hong M, Lee C et al. Comparison between sirolimus- and Paclitaxel-eluting stents for the treatment of chronic total occlusions. J Invasive Cardiol 2006; 18: 205-208
    PubMedGoogle Scholar
  • 28 Van den Branden B, Teeuwen K, Koolen J et al. Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): a randomised comparison of sirolimus-eluting stent implantation with zotarolimus-eluting stent implantation for the treatment of total coronary occlusions. EuroIntervention 2013; 9: 841-853
    CrossrefPubMedGoogle Scholar
  • 29 Teeuwen 1 K, Van den Branden BJ, Koolen JJ et al. Three-year clinical outcome in the Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III) trial: a randomised comparison between sirolimus-eluting stent implantation and zotarolimus-eluting stent implantation for the treatment of total coronary occlusions. EuroIntervention 2014; pii: 20140215-05
    PubMedGoogle Scholar
  • 30 Park H, Kim H, Lee J et al. Randomized comparison of the efficacy and safety of zotarolimus-eluting stents vs. sirolimus-eluting stents for percutaneous coronary intervention in chronic total occlusion – CAtholic Total Occlusion Study (CATOS) trial. Circ J 2012; 76: 868-875
    CrossrefPubMedGoogle Scholar
  • 31 Moreno R, García E, Teles R et al. Randomized comparison of sirolimus-eluting and everolimus-eluting coronary stents in the treatment of total coronary occlusions: results from the chronic coronary occlusion treated by everolimus-eluting stent randomized trial. Circ Cardiovasc Interv 2013; 6: 21-28
    CrossrefPubMedGoogle Scholar
  • 32 Markovic S, Lützner M, Rottbauer W et al. Zotarolimus compared with everolimus eluting stents for treatment of true coronary chronic total occlusions. DGK; Mannheim: 2014
    Google Scholar