Osamu Katoh医生：著名介入心血管病学权威，在 CTO 介入治疗中有极深造诣， CCT 主席之一。
　　International Circulation: When should we do PCI for CTO?
　　Dr Katoh: Patient background is very important. If the patient has chest pain as a result of the occlusion， they definitely need revascularization either by PCI or bypass surgery. Often the patient will have no chest pain， especially the patient with large vessel disease with clinical occlusion. More severely diseased patients often suffer from chest pain. At the time， it is very difficult to make the decision but my policy is that the patient must benefit from the revascularization compared to the medical treatment. If I can recanalize the CTO including any other stenoses safely， I will do the PCI. There are many criteria in making the decision for surgery or PCI or medication. For example， for an 80 year old woman with triple vessel disease with a chronic total occlusion but only slight chest pain， medication will be OK particularly considering her age. On the other hand， a 55 year old patient with no chest pain even after exercise who has triple vessel disease with a clinical occlusion (which is not so rare)， according to the criteria authorized by the ACC/AHA Guidelines it is difficult to make the decision for PCI for that patient. The patient may have no benefit from the revascularization but I strongly believe that such a patient showing signs of ischemia must have benefit at least over that from medication.
　　The reason that that is my policy is that I have seen many MI patients over the past 30 years. Back at the start I didn’t do PCI. I started doing PCI in 1983. At that time I did not perform primary PCI for the MI patient. I would just do the emergency angiogram and then send the patient to surgery. But I was finding so many patients in cardiogenic shock with severe heart failure had chronic occlusion in a non-culprit lesion. My speculation was that the chronic occlusion might determine the patient’s prognosis when the patient has an acute coronary event such as MI， even in a silent ischemic patient. That is why I have a strong opinion on the topic.
　　《国际循环》：应该何时对慢性完全闭塞病变（CTO）病变进行PCI治疗？
　　Dr Katoh：患者的背景信息非常重要。如果患者有因闭塞病变导致的胸痛，显然他们需要接受血运重建，不论是PCI还是旁路手术。通常患者没有胸痛症状，特别是大血管闭塞的患者。病变更严重的患者通常会出现胸痛症状。这种情况下很难做出决定，但我的原则是必须保证与药物治疗相比，患者能够从血运重建获益。如果我能够安全地开通CTO包括其他狭窄病变，那么我会选择PCI。至于选择外科手术还是PCI或药物治疗，有许多标准。例如，对于1例80岁、有闭塞性病变的三支病变的轻度胸痛患者，可能药物治疗是合适的，尤其是考虑到她的年龄。另一方面，1例55岁、有闭塞性三支病变、但即使运动后亦无胸痛的患者，根据ACC/AHA指南建议的标准难以作出PCI的决定。这类患者可能不能从血运重建获益，但我十分相信这类患者如有缺血症状，一定可以从血运重建获得超过药物治疗的益处。
　　我以此作为原则的原因是，过去30年间我看到许多MI患者。最初我不会对这类患者进行PCI，但从1983年开始我改变了态度。当时我对MI患者不会施行直接PCI，我只是进行急诊的血管造影，然后将病人送至外科。但我发现有许多发生心源性休克和严重心力衰竭的患者存在完全闭塞的非犯罪病变。我推断当患者发生MI等急性冠状动脉事件时，即使没有临床症状，其慢性闭塞病变也可能决定了患者的预后。这就是为什么我对此抱有强烈的兴趣。
 

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