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

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