International Circulation: A common Western approach seems to be to add devices. This appears to be very different from the Japanese thinking. What do you think about this?
　　Dr Katoh: The device companies know how difficult it is to cross a lesion with a CTO wire. It can cause a subintimal dissection which stops the procedure. It is difficult to continue a long procedure in the United States and Europe， as there are many patients waiting and procedures are usually restricted by time. In Japan and China， we can occupy the cathlab for three or four hours and we can continue the procedure. It is a completely different approach. We have tried the new things to open the chronic occlusion and have developed new ideas and techniques. In the United States and Europe， they give up easily. The next day they have an idea for a new device. They tried to simplify the CTO crossing， but it was impossible from the outset because in coronary stenosis there are so many kinds of occlusion. Sometimes in coronary stenosis it is very difficult to treat with PCI – a very calcified bent lesion for example. It is the same in chronic occlusion. In chronic occlusion there are all kinds of occlusions – highly calcified lesions， a tortuous vessel， bifurcation lesions， any kind of lesion can be included in chronic occlusions. To solve the problem in CTO-PCI， we have to solve all of these different situations， so it is almost impossible to achieve. The Western companies wanted to simplify the CTO crossing. This was impossible from the start， but they did not understand this. Finally， they reached the re-entry concept， with subintimal tracking which was an easier way and allows them to return to the true lumen. They were thinking of ways to recanalize with puncture or RFA， which have limitations similar to the conventional CTO wire. To do the re-entry， we have to be able to control the device. Because this was very difficult， it was necessary to develop the new antegrade approach or new CTO wires. This is the major reason I think why the device companies failed for more than twenty years.
　　《国际循环》：西方技术通用的做法似乎是增加装置（add devices），看起来与日本的理念有很大差异。您对此有何看法？
　　Dr Katoh: 生产介入器材的公司知道使用CTO导丝通过病变有多么困难。术中常导致内膜下夹层而导致不得不中止手术。在欧洲和美国通常难以实施长时间的手术，因为等待手术的病人太多，手术通常会有时间限制。而在日本和中国，我们可以联系3~4小时占用导管室，因此可以连续手术。这方面有很大差异。为开通慢性闭塞病变，我们已经尝试了许多新事物，也建立了许多新的理念和技术。欧美的医生通常很容易放弃，第二天有可能他们会想到一种新的器材，他们希望将CTO病变的开通变得简单，但这几乎不可能，因为冠状动脉狭窄有太多类型的闭塞。有时候冠状动脉狭窄难以通过PCI来治疗——例如严重钙化、扭曲的病变。CTO病变也是一样，存在各种各样的闭塞——高度钙化的病变、扭曲的血管、分叉病变等。为解决CTO-PCI，我们必须克服所有类型的状况，这几乎是不可能完成的任务。生产厂家希望简化CTO病变的开通，但最终发现这几乎不可能，便又回到了“重新进入（re-entry）”的理念，即通过内膜下跟进导丝以重新进入真腔。他们试图通过RFA（右股动脉）穿刺以开通病变，但这与传统的CTO导丝具有相同的局限性。为使导丝重新进入真腔，我们必须能够控制导丝。由于这非常困难，有必要开发用于新的正向技术的新型CTO导丝。我认为这是20余年来生产厂家一直未能成功的主要原因。
 

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