Kronične popolne zapore koronarnih arterij: Chronic total occlusions of coronary arteries: clinical significance and percutaneous treatment: klinični pomen in perkutano zdravljenje

Chronic total occlusion is the complete obstruction of the coronary artery, which lastsfor at least 3 months. The loss of blood supply, which is partly reduced by collateral circulation,leads to ischemia with symptoms such as angina pectoris as well as an increasedincidence of arrhythmias and heart failure. The most important non-invasive diagnostictests pointing to ischemia are the ECG and echocardiography, while a definitive diagnosiscan be made with coronarography. Scintigraphy is important for the assessmentof myocardial viability. The treatment can be conservative, surgical or percutaneous. Despitetechnological advances and new techniques, CTO revascularizations represent only 10-15% of all coronary procedures. Most procedures are made using an anterograde approachand, in difficult cases, using a retrograde approach through septal and epicardial collaterals.The site of the former occlusion is further protected by a drug eluting stent, whichreduces the incidence of restenosis to less than 10%. The incidence of complications iscomparable to other interventional procedures, the most common being coronary arteryperforation. Studies suggest that CTO revascularization improves survival, left ventricularfunction and reduces the symptoms of angina pectoris. Revascularization also improvesthe prognosis of possible myocardial infarction.