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CIT国际视野丨CTO有时应“无为而治”,准分子激光为CHIP介入治疗带来新助力!
 编辑:国际循环网 时间:2021/5/13 16:55:17    加入收藏
 标签:  关键字:CHIP介入治疗 

     编者按:2021年5月6~9日,第十九届中国介入心脏病学大会(CIT 2021 Online)于线上盛大召开,会议形式涵盖开幕式、全体大会合作伙伴会议、最新临床试验和手术转播等内容,全球心血管领域专家学者齐聚云端,共探学术进展。本刊特邀阿根廷福尔摩沙综合医院Gustavo Samaja教授就复杂、高危、有介入治疗指征(CHIP)患者的介入治疗相关问题进行专访。

 
 
    《国际循环》:CHIP冠状动脉粥样硬化性心脏病患者越来越多,且常合并慢性完全闭塞(CTO)病变,对介入治疗提出更高要求。如何优化钙化病变的介入治疗?请谈谈您的观点?

    Gustavo Samaja教授:我认为,对于高风险患者,正确的方法是要查看其整体情况,而不应仅关注患者是否合并CTO。例如,应该考虑患者的风险、干预的预期获益、干预本身成功的机会以及所在医院的资源和技术水平、手术取得成功的概率等。总之,我们要综合评估之后,再制定治疗方案。
 
 
    《国际循环》:什么情况下CTO可以不做处理?

    Gustavo Samaja教授:如果介入治疗风险大于预期获益,可以不处理CTO。关于这一点,我想引用中国经典著作《道德经》中的理念:“无为而治”,有时我们最好什么也不做,即只对患者进行药物保守治疗。如果患者是没有心绞痛的低风险患者,并且在日常生活中没有任何问题,那么,就很难再改善其生活质量,因为他的状态已经很好了。如果患者是高危患者,但手术干预不会增加其生存率,则最好的办法也是什么都不做,这正如老子所提出的观点,无为而治。
 
 
    《国际循环》:您如何看待准分子激光(ELCA)在CHIP PCI中的应用?

    Gustavo Samaja教授:ELCA是一种很好的工具,但在我们国家尚缺乏有关资源,我们并未使用它。我不确定高风险患者的情况,因为该过程本身很耗时,而且该风险高于如果您准备在顺行或逆行波中进行经典CTO再通时的风险。因此,ELCA是一种很好的工具,我们应该在适时的时机使用它。
 
 
    《国际循环》:目前,对于CHIP的介入治疗研究主要侧重在哪些方面?

    Gustavo Samaja教授:我认为CHIP介入治疗的重点是分析哪些患者最适合接受治疗,此外我们应当认识到,CHIP不仅仅限于导管实验室内,还与患者的准备有关。当然,这与手术本身也有关,但对于CHIP患者来说,护理确实很重要。换言之,如果世界上最好的介入心脏病专家,在导管室完成了一台非常完美的CHIP介入手术,但如果手术之后不能很好地护理患者,那么患者的预后仍然不佳,且患者可能会为此付出更大的代价。
 
    专访原文
 
    《International Circulation》: There are more and more Complex Higher-risk and Indicated Patients with coronary atherosclerotic heart disease for interventional therapy, and they often have CTO lesions, which puts forward higher requirements for interventional therapy. How to optimize the calcified lesions PCI? Would you please share us your opinion?

    Professor Gustavo Samaja:I think that for higher risk patients, the correct approach is to see the entire picture. It is a bad idea to focus only on if the patient has or has not a CTO. You should consider the risk of the patient, the benefit expected for your intervention, the chance of having success of the intervention itself, and the chance of having success in your center with your resources and skills. And, after that, you should take the decision.
 
    《International Circulation》: When can we leave a CTO Untreated?

    Professor Gustavo Samaja:We can leave a CTO untreated when the risk of the intervention is bigger than your expected benefit. About that, let me share with you some talk from the Tao Te Ching, the classical book: “Act without action.” Sometimes it’s best to do nothing, which means medical treatment. If the patient is a low risk patient with no angina, with no problem in everyday life, it is hard to improve his quality of life because it’s already good. And if the patient is a higher risk patient, but your intervention will not add benefit on survival, I think that the best idea is to do nothing—as Laozi said a long time ago.

    《International Circulation》: What do you think about the application of ELCA in CHIP PCI?

    Professor Gustavo Samaja: I think it is a good tool. Unfortunately, in my country, with low resources—we don’t have the resources of the developed world—we don’t use it. But, I think that I can’t deny that it’s a good tool. I’m not sure about the situation in higher risk patients because the procedure itself is time consuming, it’s contrast consuming, and the risk is higher than the risk if you prep for a classical CTO recanalization in antegrade or retrograde wave. So, I will say that it’s a good tool. You should keep this tool in mind when you can.

    《International Circulation》: At present, what are the main focus of interventional therapy research for CHIP?

    Professor Gustavo Samaja: I think that the main focus is to analyze which is the best patient for being treated. And considering that, you should keep in mind that CHIP is not only about the cath lab. CHIP is about the preparation of the patient. It’s about the procedure itself, of course, but it is really important in this group of patients—the post-operative daycare of the patient. I mean, if you add the best interventional cardiologists in the world and you do magic in the cath lab, but after the procedure you don’t have a good care of the patient, in the cases of CHIP patients, the patient will pay a high price for this mistake.
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