Abstract：
BACKGROUND: The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is lower and the risk for complications higher compared with other non-CTO PCI. Although interventionalists focus on intimal plaque characteristics, the coronary media is an important (especially for techniques involving antegrade dissection and re-entry) but poorly understood structure in CTO PCI.
OBJECTIVE: The aim of the present study was to investigate coronary medial wall thinning in CTO lesions and determine how this thinning might affect CTO PCI.
METHODS: A total of 2,586 sections were investigated, from arteries with evidence of CTO from 54 subjects (1,383 sections) and arteries without evidence of CTO from 54 subjects with non-coronary-related deaths (1,203 sections) after matching for age, gender, body weight, and body height.
RESULTS: The medial thickness in subjects with CTO was lower than that in those with non-coronary-related death (P < 0.001). In subjects with CTO, CTO lesions had thinner medial walls compared with those with lower luminal narrowing (P < 0.001). At the CTO distal segments, the 6- to 12-mm distal segment from the distal end of the CTO had significantly less luminal narrowing (P < 0.001), and similar medial thickness, compared with the distal end of the CTO. Immunohistochemical analysis revealed that short-duration CTO had more cleaved caspase-3-positive cells in media and had significantly more CD3+, CD4+, CD8+, and CD4+CD28null T cells compared with long-duration CTO.
CONCLUSIONS: CTO lesions demonstrated coronary medial thinning compared with non-CTO lesions. Further investigation of the cause-and-effect relationship among inflammation, apoptosis, and coronary medial wall thinning is warranted in future mechanistic studies.
OBJECTIVE: The aim of the present study was to investigate coronary medial wall thinning in CTO lesions and determine how this thinning might affect CTO PCI.
METHODS: A total of 2,586 sections were investigated, from arteries with evidence of CTO from 54 subjects (1,383 sections) and arteries without evidence of CTO from 54 subjects with non-coronary-related deaths (1,203 sections) after matching for age, gender, body weight, and body height.
RESULTS: The medial thickness in subjects with CTO was lower than that in those with non-coronary-related death (P < 0.001). In subjects with CTO, CTO lesions had thinner medial walls compared with those with lower luminal narrowing (P < 0.001). At the CTO distal segments, the 6- to 12-mm distal segment from the distal end of the CTO had significantly less luminal narrowing (P < 0.001), and similar medial thickness, compared with the distal end of the CTO. Immunohistochemical analysis revealed that short-duration CTO had more cleaved caspase-3-positive cells in media and had significantly more CD3+, CD4+, CD8+, and CD4+CD28null T cells compared with long-duration CTO.
CONCLUSIONS: CTO lesions demonstrated coronary medial thinning compared with non-CTO lesions. Further investigation of the cause-and-effect relationship among inflammation, apoptosis, and coronary medial wall thinning is warranted in future mechanistic studies.
摘要：
背景：与其他非CTOPCI相比，慢性完全闭塞（CTO）的经皮冠状动脉介入治疗（PCI）的成功率较低，并发症的风险较高。尽管介入医生关注内膜斑块特征，冠状动脉介质在CTOPCI中是重要的(尤其是涉及顺行解剖和折返的技术),但对其结构了解甚少。
目的：本研究的目的是研究CTO病变的冠状动脉内壁变薄，并确定这种变薄如何影响CTOPCI。
方法：共调查了2,586个切片，来自54名受试者（n=1,383个切片）的CTO证据的动脉和来自54名非冠状动脉相关死亡受试者（n=1,203个切片）的无CTO证据的动脉，性别,体重,和身体高度。
结果：CTO患者的中层厚度低于非冠状动脉相关死亡患者（P<0.001）。在CTO的科目中，与管腔狭窄程度较低的患者相比，CTO病变的内壁较薄（P<0.001）。在CTO远端,CTO远端的6-12-mm远段管腔狭窄明显较少（P<0.001），和相似的内侧厚度，与CTO的远端相比。免疫组织化学分析显示，短期CTO在培养基中有更多的caspase-3阳性细胞，并且有更多的CD3+，CD4+,CD8+,和CD4+CD28nullT细胞与长期CTO相比。
结论：CTO病变与非CTO病变相比显示冠状动脉内侧变薄。进一步研究炎症之间的因果关系，凋亡，冠状动脉内侧壁变薄在未来的机制研究中是有必要的。
目的：本研究的目的是研究CTO病变的冠状动脉内壁变薄，并确定这种变薄如何影响CTOPCI。
方法：共调查了2,586个切片，来自54名受试者（n=1,383个切片）的CTO证据的动脉和来自54名非冠状动脉相关死亡受试者（n=1,203个切片）的无CTO证据的动脉，性别,体重,和身体高度。
结果：CTO患者的中层厚度低于非冠状动脉相关死亡患者（P<0.001）。在CTO的科目中，与管腔狭窄程度较低的患者相比，CTO病变的内壁较薄（P<0.001）。在CTO远端,CTO远端的6-12-mm远段管腔狭窄明显较少（P<0.001），和相似的内侧厚度，与CTO的远端相比。免疫组织化学分析显示，短期CTO在培养基中有更多的caspase-3阳性细胞，并且有更多的CD3+，CD4+,CD8+,和CD4+CD28nullT细胞与长期CTO相比。
结论：CTO病变与非CTO病变相比显示冠状动脉内侧变薄。进一步研究炎症之间的因果关系，凋亡，冠状动脉内侧壁变薄在未来的机制研究中是有必要的。
