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摘要: 冠状动脉慢性完全闭塞病变(CTO)是冠心病的重要类型。CTO起病隐匿，早期症状不典型，若不及时干预导致远期预后较差。随着我国人口老龄化的加速发展和对急性冠状动脉综合征的防控普及，确诊的CTO患者占比呈逐步上升的趋势。近年来医疗水平及影像技术不断进步，术前冠状动脉计算机断层扫描血管造影(CTA)和冠状动脉造影(CAG)在冠状动脉疾病检查中广泛应用，临床对CTO病变检出率及诊疗认识不断深化，手术设施也更完善，使CTO的诊断及治疗都取得了极大进展。本综述旨在讨论CTO病变的发病机制、临床诊断及治疗的最新进展。Abstract: Coronary artery chronic total occlusion (CTO) is an important subtype of coronary atherosclerotic heart disease. CTO has an insidious onset and atypical early symptoms, which can lead to a poor long-term prognosis if not treated in a timely manner. With the accelerated development of China's aging population and the popularization of prevention and control of acute coronary syndromes, the proportion of patients diagnosed with CTO is on a gradual upward trend. In recent years, medical standards and imaging technologies have been advancing, and preoperative coronary computed tomography angiography (CTA)and coronary angiography(CAG) have been widely used in the examination of coronary artery disease, clinical understanding of the detection rate and diagnosis and treatment of CTO lesions has been deepening, and the surgical facilities have been improved, so that the diagnosis of CTO and the treatment of CTO have made great progress. The purpose of this review is to discuss the latest advances in the pathogenesis, clinical diagnosis, and treatment of CTO lesions.
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Key words:
- chronic total occlusion /
- diagnosis /
- treatment /
- imaging examination
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表 1 CTO相关CAG与CTA影像检查优缺点比较
Table 1. Comparison of the advantages and disadvantages of CTO-related CAG versus CTA imaging examinations
项目 优点 缺点 CAG 金标准
具有高灵敏度和特异度
准确显示冠脉狭窄、迂曲程度、有无侧支血管有创、对钙化灵敏度较低
检查时间长，需住院检查，费用高
有出血、感染、心率失常等风险CTA 无创、检查时间短
对钙化灵敏度和特异度较高
可清晰显示闭塞血管远端图像易受体位、呼吸影响产生伪影
图像分辨率有限，对次全闭塞(狭窄>90%)和CTO的诊断有限
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