Téma: 

Chronic total occlusion (cto) of coronary artery – the last challenge for intervention cardiologist

Jozef Pacák, Viliam Fridrich, Martin Gočár, Stanislav Mizera, Branislav Liška

Chronic total occlusion (CTO) of the coronary arteries is defined as a lesion with complete stop of the antegrade flow of the contrast agent old more than 3 months. Histologic and pathologic findings have showed that in the presence of angiographic occlusion we can find micro-channels in approximately half of the cases. It can help to cross the CTO lesion with the guide-wire during percutaneous coronary revascularization of the occluded artery (CTO-PCI). CTO can be found in approximately up to the 30 % of the diagnostic coronary angiography but the CTO-PCI is attempted in only a small number of lesions despite the data from the large registries of unselected groups of patients with the CTO have approved the benefit of elimination or mitigation of symptoms, reduction of the need of the coronary artery bypass operations and improving the long term prognosis. The main reason for a low frequency of CTO-PCI is the lower success rate of the PCI in that subset lesion. But specialized centers show an improvement in the success rate of the CTO-PCI up to the 80 %. In the National Institute of Cardiovascular Diseases the rate of the CTO-PCI is low, 3 %, despite the high frequency of the successful PCI CTO procedures (88.7 %). This fact shows the high threshold for CTO-PCI. According to EuroCTO Club Recommendations, it is useful to create skilled, sub-specialized CTO/PCI.

Ročník 2009  Témy časopisu Cardiology for practice 3 / 2009

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MUDr. Peter Dědič
MUDr. Juraj Dúbrava, PhD., FESC
MUDr. Viliam Fridrich, PhD.
doc. MUDr. Ján Kmec, PhD.
MUDr. Gabriela Kaliská, PhD., FESC
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6. Bibliography
Citations are numbered chronologically in bold, references in the text are stated by the number of citations in parentheses. Use maximum 30 citations.

Examples of citations:
1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981: 15-27.

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In which patients, after overcoming of a thromboembolic cerebral or peripheral event, the least suitable catheter closure is foramen ovale patents:
a. a woman before planned pregnancy
b. paroxysmal fibrillation of the atrium
c. aneurysm of the atrium septum
d. origination of an event after cough

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