??????????? (??? ??????? 15-30 ???? ? ??????? ??????????? ?????????) ???????? ?????????? ??????? (????) ??????? ?? ????????? (??????????? ???????? ??????????? — TIMI 0) ??? “??????????????” (??????????? ???????? ???????? ????????? ??????????????? ????? – TIMI I) (1).
???? ?? ?????? ?????????? ??????????? ? 5-15% ???? ?????????? ???????????? (1), ? ? 31% ?? ?????? ?????????? ???? ???????? ?? ?????? ?????????????? ?????????? ????????????????? ?????????? (????). ????? ??? ? ??????????????? ????????????????? ??? ???? ??????????? ? 20-40% (2, 3). ? 1824 ?????????, ??????? ? ???? ????????? ?????????????? , ???? ???? ???????? ? 934-? ???????. ??????????? ?????????? ?????????????? ????????? ?? ??????? ???? ???? ? ????????? ?????????? ????????? ? ??????????????? ???????????? ??? ???.
?????????????????? ???? ??????? ?? ?????????? ???????????: ???????? ??????????????????? ??????, “???????” ?????? ? ????????? ????? (4). ? ???????? ??????? ? ????????? ????? ? ?????? ????? ?????????????? ?????? — “neo-channel” ? ? ????????? ? ?????????? vasa vasorum ??? ????? ????????? ? ??????????, ????????? ????????????? ???????? ???????????????? ???????? (5). ??????????????? ?????? ???????? ??????????? ??? “bridging” ??????????? ? ???????? ????? ?? ??????????????? ???????? ??? ????????? ?????????? ?????????? ????????????? ???? (6).
???????? ?????????? ??????? (??), ??? ???????, ???????? ? ???????? ???????? (??) (7). ??????, ? ???? ??????? ????????? ????????? ???????????? ???????? ? ???? ?????????????? ??????????????? ?? ???? ????????, ? ? ???????????? ????? ??????? ??????????? (
. ? ???? ???????? ?????????? ????????????? ?????????????? ?? ??????????? ?????????????? ???????? ????? — ??????????? ???????????? ????????? ? ??????????????? ????????. ??????????? ?????????????????? ? ??????????????? ???????? ? “??????? ???????????????” ??????????????? ?? ??????? ?? ???????? ?????????????? ???????? (9), ??????? ??????????????? ????????? (10), ???????????? ????????? ????????? ??????????????? (11). ? ???? ???? ????????? ?????? ??????????????? ????????? ? ??????????????? ?????????? ??????? ? ????????? ? ???????? ? ??????????? ???????? ???????? ? ????????, ??????????? 193 ? 102 ???????? ??????????????. ?????? ??????, ??? ?????????????? ?????????????? ???????? (0-1 ????????) ?????????? ???? ??????????? ????? ?????????, ?????????? ??????? ???????? ? ?????? Q (0 ??. — 10 (5,1%), 1 ??. — 71 (36,9%)), ?????? ??? ? ?????? ???????, ????????????????? ????????? ???????? ??? Q ??? ??????????? ??????? ????? ?????? ? ???????? (0 ??. – 0 (0%), 1 ??. — 15 (14, 7%)). ????????, ?????????????????? ?????????????? ???????? (2-3 ????????) ? ??????????????? ?????????? ??????? ?????????? ???? ????? ????? ? ??????? ??? ?????????????? ????????? ? ???????? (2 ??. — 71 (69,6%), 3 ??. — 16 (15,7%)), ??? ????? ??? ?????????? ??????? ???????? ? ?????? Q (2 ??. — 102 (52,9%), 3 ??. — 10 (5,1%)).???? ?????????? ????????????? ??? ????: 1) ?????????? ??????????? ???????? ? ??????????????? ???????? ? ???? ??????????????? ??????????????? ?? ?, ????? ???????, ?????????? ??????????? ?????????? ?????? (12); 2) ?????????? ?????????????? ??????????????? ??, ????? ???????? ????????, ?????????????? ????????? (13), ? ?????? ???? 3) ???????????? ???????? ?? ????????? (14), ?? ???? ?????????? ????????? ?????? ????????? ?, ??????????????, ?????????? ??? ?????????????? ????????????. ?????????????? ?????????? ??? ?????????? ???????????????? ????? ??????? ????? ??????????? ??????????????? ????????? ? ?????? ??????? ??? ??????????????? ????????? ? ?????????? ?????????? ??????????? ???????? ???.
???????? ?? ???? ????????? ?????????? ?????????????, ?????????????? ? ??????? 2 ? 3, ????? ???????? ???????????? ????????? ?????? ? ?????????????? ????? ???????? ???????? – ?????????? ?????????????? ????? ?? ??????? ???? ????????? ??? ????????? ????????????? ???????? ? ????? ?? ??????????? ?????????????. ???????????, ??? ?????? ???????? ????????? ????????? ? ?????????????? ???????, ? ??????? ??? ??????? ???????? ? ???? ??????? ???????? ?????????????? ???????. ?????????????? ?????????????? ? ?????????? ????????????? ? ?????????????? ??????? ? ???? ?????? ????????? ?????????? ????? ??????????????? (1, 6).
????? ????????????? ?? ?????? ????????? ???????????? ?????????? ?? 42% ?? 72% ? ??????? ?? ?????? ???????? (15). ? ??????????????? ??????????? ?????? ????????? ???????: ????? ????????????? ???? ????? 3 ???????, ?????????? ????????????? ???? (????? 15 ??), ??????? “bridging” ????????????, ?????? ???????????????? ??????? ???????? ?????, ?????????? ???????????? ?????????? ?????????? ????? ??????, ??????????? ??????? ????? ? ????? ?????????????? ???? ????????, ?????????, ?????????? ????????? ? ????????? ????????? ????????????? ????? ??????. ? ????? ?????? ???????? ????? ????? ????????? ??????? ?? ??????? ????????????? ????????, ????????????? ????, ??????????? ??????? ????? ? ???????????????? ???????? ? ??????? ???????? ? ??????? “bridging” ????????????. ??? ???????????? ??????? ??????? ????????????? ???????? ?? ????? ?????????? ????????????? ???? ???? ???????????, ??? ??? ?????????? ????????? ????? 1 ????? ????? ???????? ???????????????? ????????? 93% ???????, ????? 2-3 ?????? – 68%, ? ????? 3-9 ??????? ?????? 44%. ???? ???? ?????? ?????????????? ?????????? ????? ????????? ????????? ?????????? ?????????????? ???? ????????? ????? ????????????? ???????? ???????? ? ????????? ????? ????? ???????? (????? 15-30 ????).
??????????? ????????? ??? ????????????? ???? ?????????? ?? ?????? ???????????????? ???????? ? ???? ???????? ? ?????????? ? ??????????? ?????? ?????????. ??????????? ????????? ????? ??????? ???????? ? ????????????? ??????? (??????????? ??? ????????????????), ?? ?????? ???????? ?? ????? 1 ?????? ??? ??????????????? ???????? ??? ????????? ?????????? ?????????????. ??? ?? ?????, ? ????? ??????? ?????????? ????????????? ??????? ??????????????? ???????? ? ???? ???????? ?? ?????? ???????????? ??? ?????????? ?????????????.
? ????? ?????? ?? ?????????? ????????? ??????????? ?????? ??? ????????????? ????:
— ????? ?????????????? ????????, ??????????? ??????? ?????????? ??? ?????????? ????????????????? ?????????????? (?xtra-back-up ??? ????? ?? ? Amplatz right — ??? ?????? ??);
— ????????? ??????????? ?????????? ??? ?????? ???????????? ? ????????????? ????? ???????? ?????????? ????????;
— ???????????????? ????????????? ???????? ?????????? (intermediate ??? stand?rt) ? ????????????? ?????????? (Shinobi, Cordis);
— ???????? ???????????? ???????? ? ????????????????? ?????????? ??????? ? ????????????? ???? ???????? ??? ???????? ??????????? ???????????? ??????????? ?????????? ? ?????????? ????? ??????. ????? ? ???? ????? ?????????? ???????? ??????????, ? ???????????? ?????????? ? ?????????? ????? ????? ?? ?????????? ???????? J ???????;
— ????????????? ???????? Tacker ? ???????? Omnipass ????? Cordis ??? ?????????? ????? ????????;
— ??? ????????? ????????????? ????????? ???????? “???????????” ??????? ?? ???? ???????? ?????????????? ???????? ????????? ????????? ??????? ?????????? ???????? ???????? ? ? ??????????? ??????? ?? ???????????? ????? ??????.
?????????? ?????????? ?????????? ????????????? ????, ??????????? ? ???? ?? ?????? ? ??????, ??? ?? ????? ????????? ????????? ???????????? ??????? ???? ???????????????? ??????????. ?????? ?????????? ????????????? ? ???? ???? ????????? ? ??????? 1997 ????. ???????? ????????? ????????????? ???? ? ???? ???? ???? ????????? ? 25% ?????????. ? 1998 ???? ???? ?????????? ???????? 52%, ? ? 1999 ??? 76%. ???? ???????? ? ??????? ?????????? ????????????? ???? ?? ????????? ?? ?????? ? ????????????? ???????????? ????? ????? ????????????, ?? ????? ? ?????????? ??????? ????????? ?? ????????? ? ??????? ?? ??????????? ??????????? ???????.
? ?????????? ???????? ?? ????????, ??? ????- ?????? ??????????????????? ??????? ? ???, ?????????? ??? ? ? ????????? ?????? ?? ????? ??????????? ??????? ??????????? ??????? ? ?????? ??? ????????? ?????????? ?????????????. ? ?????????, ? ????? ?????? ? ?????? ?????????, ? ??????? ???????? ????? ??????????? ???? (??? ???????? ????? ????????????? ???????? ????????) ?? ?????? ??????????? ?????? ??? ?????????? ??????????????? ????????, ???, ??? ??? ???????, ???????.
??????????
1. B. Chevalier, T.Royer, P. Guyon, B. Glatt “Chronic Total Occlusion” in book J Marco et all “The paris Course on Revascularisation 2000”; p.131.
2. Baim D.C., Ignatius E.J.: Use of percuteneous transluminal coronary angioplasty: Results of a current survey. Am. J. Cardiol. 61:3G-8G, 1988.
3. Delacertaz E., Meier B.: Therapeutic strategy with total coronary artery occlusions. Am. J. Cardiol. 79: 185-187, 1997.
4. Srivatsa S.S., Edwards W.D., Boos C.M. et al: Histologic correlates of angiographic chronic total coronary artery occlusion: Influence of occlusion on neovascular channel patterns and intimal plaque composition. J. Am. Coll. Cardiol. 29: 955-963, 1997.
5. Roberts W.C., Virmani R.: Formation of new coronary arteries within a previously obstructed epicardial coronary artery (inarterial arteries): A mechanism for occurence of angiographically normal coronary arteries after healing of acute myocardial infarction. Am. J. Cardiol. 54: 1361-1362, 1984.
6. Omogui N.A., Ellis S.G.: The Chronic Occlusion In book: “Strategic Approaches in Coronary Intervention” Stephen G.Ellis and David R.Holmes, Editors p.380-384, 1997.
7. DeWood, M.A., Spores J., Notske, R.N., et al.: Prevalence of total coronary artery occlusion during the early hours of transmural myocardial infarction. N. Engl. J. Med. 303:897, 1980
8. Greenberg H, McMaster P, Dwyer EM, Jr, and the Multicenter Post-Infarction Research Group. Left ventricular dysfunction after acute myocardial infarction: Results of a prospective multicenter study. J Am Coll Cardiol 1984; 4:867-74.
9. Dacanay, S., Kennedy, H. L., Uretz, E., et al.: Morphological and quantative angiographic analyses of progression of coronary stenoses: A comparison of Q-wave and non-Q-wave myocardial infarction. Circulation 90:1739, 1994.
10. Sabia, P.J., Powers, E.R., Ragosta, M., et al.: An association between collateral blood flow and myocardial infarction. N. Engl. J. Med. 327:1825-1831, 1992.
11. Oliva PB. Pathophysiology of acute myocardial infarction, 1981. Ann Itern Med 1981;94:236-50.
12. Melchior J.P., et al: Improvement of left ventricular contraction and relaxtion synchronism after recanalization of chronic total coronary occlusion by angioplasty. J. Am. Coll. Cardiol. 4: 763-768, 1987.
13. Danchin N, Angio M, Cador R, et al: Effect of late percutaneous angiografic recanalization of total coronary artery occlusion on left ventricular remodeling, egection fraction, and regional wall motion Am. J. Cardiol 78: 729-735, 1996.
14. vanhoe R.J., Weintraub W.S., Douglas J.S. Jr., et al: PTCA of chronic total occlusions: Primary success, restenosis, and long term clinical follow-up. Circulation 85: 106-115, 1992.
15. Kaufmann U., Meier B.: The Chronic Occlusion In book: “Strategic Approaches in Coronary Intervention” Stephen G.Ellis and David R.Holmes, Editors p.394-407, 1997.
??????? ?.?., ?????? ?.?., ???????? ?.?., ????? ?.?., ??????????????? ????????????? ????????? ??????????? ???????????????? ?????????, ????????? ??????? ???????????
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