Download - TomaszJ. Guzik - Is chronic total occlusion a step in atherosclerosis natural progression or more?
Is chronic total occlusiona step in atherosclerosis natural progression
or more?
Tomasz J. Guzik
What Should We Know About Prevented, Diagnostic, and Interventional Therapy in Coronary Artery Disease", book edited by Branislav G. Baskot
Media
Media
Neointima
Neointima
Loose connective tissue
Sclerotic connective tissue
Calcification
Calcification
Loose connective tissue
ThrombusNeovasculature
Neovasculature
Cholesterol crystals
PVAT PVAT
Calcification
Katsuragawa et al:
Srivatsa et al, 1997, JACC
Atherosclerosis starts early… maybe early start is a risk factor for TCO?
New Engl J Med, 1998
New Engl J Med, 1998
How does atherosclerotic plaque appear?
Good endothelial function
Dysfunctional endothelium
NO PGI2 CNP EDHF
ET PGH2 O2- TXA2
Risk factors for atherosclerosis
Endothelial Dysfunction
Guzik et al, Circulation, 2002
Starting point ACh
4 years later
NTG
Schachinger, Circulation, 2000
ConstrictionInstead of relaxation
Srivatsa et al, 1997, JACC
Plaque evolution
Sakakura et al., Int Cardiovasc Res J.2016;10(2):55-60
But…
Guzik et al, Thrombosis and Haemostasis, 2013
Is CTO pathogenesis a consequence of „chronic plaque indtability”
Neovascula-rization
Central vascular channels
Srivatsa et al, 1997, JACC
Plaque composition
CTO Inflammation score
Srivatsa et al, 1997, JACCSagan, Thrombosis&Hemostasis, 2016
Will it be a chronic consequence of plaque stabilization?
Fibro-calcified Calcified
Srivatsa et al, 1997, JACC
Trends in Cardiovascular Medicine, 2014
CTO Biomarkers?
Mikro RNA
Lib
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& P
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Cir
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