ХРОНИЧЕСКИЕ ТОТАЛЬНЫЕ ОККЛЮЗИИ КОРОНАРНЫХ АРТЕРИЙ: СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ И ВЫЗОВЫ ИНТЕРВЕНЦИОННОГО ЛЕЧЕНИЯ

Основные положения

• Чрескожное коронарное вмешательство (ЧКВ) при ХТОКА является эффективным методом лечения у пациентов с рефрактерной стенокардией, способствуя улучшению качества жизни и снижению симптомов ишемии при условии тщательного отбора и планирования.
• Предпроцедурное планирование, включающее ангиографию с двойным контрастированием, КТ-коронарографию и использование валидированных шкал (J-CTO, PROGRESS-CTO, CT-RECTOR), играет решающую роль в выборе оптимальной тактики вмешательства и снижении риска осложнений.
• Алгоритмический подход и мультидисциплинарное взаимодействие повышают успешность и ЧКВ при ХТОКА, особенно при применении гибридных и глобальных стратегий, адаптированных к анатомическим особенностям поражения.

Резюме

Хронические тотальные окклюзии коронарных артерий (ХТОКА) представляют собой одну из наиболее сложных форм поражения коронарного русла, встречающуюся примерно у 15–20% пациентов с ишемической болезнью сердца, подвергающихся коронароангиографии. Несмотря на длительное отсутствие единого подхода к лечению, за последние десятилетия интервенционная стратегия при ХТОКА претерпела значительные изменения, что связано с развитием технологий визуализации, совершенствованием проводниковых и катетерных систем, а также внедрением алгоритмического подхода к выбору тактики вмешательства. Чрескожное коронарное вмешательство (ЧКВ) при ХТОКА позволяет эффективно устранять симптомы стенокардии, улучшать качество жизни и функциональный статус пациентов при минимизации риска тяжелых осложнений. Ключевую роль в успешности процедуры играет тщательное предпроцедурное планирование, включающее использование коронароангиографии с двойной инъекцией, КТ-коронарографии и оценку анатомической сложности с помощью шкал J-CTO, PROGRESS-CTO и CT-RECTOR. Применение гибридного и глобального алгоритмов ведения ХТОКА, ориентированных на морфологию поражения, способствует индивидуализации стратегии и повышению эффективности вмешательства. Опыт оператора, наличие специализированного оборудования и слаженность команды также оказывают существенное влияние на исход процедуры. Настоящий обзор обобщает современные подходы к диагностике, планированию и выполнению ЧКВ при ХТОКА, акцентируя внимание на мультидисциплинарном подходе и роли инновационных методов визуализации в повышении безопасности и результативности лечения.

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