Microvessels in chronic total occlusions: pathways for successful guidewire crossing?
Arterial chronic total occlusions (CTO) are a common and clinically relevant problem in patients with coronary artery disease. Percutaneous coronary intervention (PCI) success rates in a wide range of CTO are low, primarily due to inability of guidewire crossing. The pathophysiology of CTO is poorly understood and limits our ability to introduce innovative therapies. Recent studies from our laboratory have suggested that microvessel formation within arterial CTO is a complex process with temporal and regional differences. Moreover, there is evidence from pilot studies that the presence of either microvessels or the particular extracellular matrix environment in the adjacent perivascular tissue can facilitate guidewire crossing and successful PCI. Currently, studies are underway in our experimental CTO model to delineate the pathophysiology of microvessel formation in CTO and its potential role in PCI.
Strauss
Bradley H
BH
The Roy and Ann Foss Cardiovascular Research Program, Terrence Donnelly Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada. straussb@smh.toronto.on.ca
Segev
Amit
A
Wright
Graham A
GA
Qiang
Beiping
B
Munce
Nigel
N
Anderson
Kevan J T
KJ
Leung
General
G
Dick
Alexander J
AJ
Virmani
Renu
R
Butany
Jagdish
J
D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D002908:Chronic Disease; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009389:Neovascularization, Pathologic; D013923:Thromboembolism / Q000175:diagnosis / Q000503:physiopathology*