{"id":155631,"date":"2026-03-17T15:59:09","date_gmt":"2026-03-17T08:59:09","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=155631"},"modified":"2026-03-17T16:45:23","modified_gmt":"2026-03-17T09:45:23","slug":"dieu-tri-ton-thuong-tac-man-tinh-mach-vanh","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/dieu-tri-ton-thuong-tac-man-tinh-mach-vanh\/","title":{"rendered":"T\u00ecm hi\u1ec3u v\u1ec1 ph\u00e1c \u0111\u1ed3: \u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh m\u1ea1ch v\u00e0nh"},"content":{"rendered":"

Xem v\u00e0 t\u1ea3i file PDF T\u1ea0I \u0110\u00c2Y<\/a>.<\/p>\n

M\u1ede \u0110\u1ea6U<\/h2>\n
Hi\u1ec7n nay t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh m\u1ea1ch v\u00e0nh (Chronic Total Occlusion CTO) kh\u00e1 th\u01b0\u1eddng g\u1eb7p v\u00e0 xu\u1ea5t hi\u1ec7n trong nhi\u1ec1u b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau. \u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng CTO l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng v\u00e0 k\u1ef9 thu\u1eadt, \u0111\u00f2i h\u1ecfi s\u1ef1 h\u1ee3p t\u00e1c ch\u1eb7t ch\u1ebd gi\u1eefa b\u00e1c s\u0129 n\u1ed9i tim m\u1ea1ch v\u00e0 b\u00e1c s\u0129 tim m\u1ea1ch can thi\u1ec7p c\u0169ng nh\u01b0 b\u00e1c s\u0129 ph\u1eabu thu\u1eadt tim.
\nC\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng nh\u1edd k\u1ebf ho\u1ea1ch ti\u1ebfp c\u1eadn tr\u01b0\u1edbc t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh bao g\u1ed3m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh h\u1ecdc kh\u00f4ng x\u00e2m l\u1ea5n, thi\u1ebft b\u1ecb can thi\u1ec7p m\u1ea1ch v\u00e0nh (Percutaneous Coronary Intervention – PCI) ti\u00ean ti\u1ebfn, k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt tim m\u1edbi v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u ch\u1ed1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/p>\n
\u0110\u1ecaNH NGH\u0128A<\/h2>\n
Theo CTO Academic Research Consortium (CTO-ARC), t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1eafc ho\u00e0n to\u00e0n \u0111\u01b0\u1eddng k\u00ednh l\u00f2ng m\u1ea1ch v\u00e0nh t\u1eeb \u00edt nh\u1ea5t 3 th\u00e1ng, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u00ean h\u00ecnh \u1ea3nh ch\u1ee5p m\u1ea1ch v\u00e0nh nh\u01b0 l\u00e0 d\u00f2ng ch\u1ea3y TIMI 0 qua ch\u1ed7 t\u1eafc, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng huy\u1ebft kh\u1ed1i m\u1edbi, kh\u00f4ng \u0111\u1ecdng c\u1ea3n quang \u1edf \u0111\u1ea7u t\u1eadn g\u1ea7n (proximal cap) t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00f3 tu\u1ea7n ho\u00e0n b\u1ea3ng h\u1ec7 ph\u00e1t tri\u1ec3n \u0111\u1ebfn \u0111o\u1ea1n xa sau ch\u1ed7 t\u1eafc.
\nX\u00e1c \u0111\u1ecbnh th\u1eddi gian m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc th\u01b0\u1eddng r\u1ea5t kh\u00f3 n\u1ebfu kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh ch\u1ee5p m\u1ea1ch v\u00e0nh \u0111\u00e3 b\u1ecb t\u1eafc tr\u01b0\u1edbc \u0111\u00f3. Trong \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p, th\u1eddi gian m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc th\u01b0\u1eddng d\u1ef1a tr\u00ean th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng hay ti\u1ec1n c\u0103n nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT) m\u00e0 \u0111\u00e3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u00f9ng nh\u1ed3i m\u00e1u tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
T\u1ea6N SU\u1ea4T<\/h2>\n
T\u1ed5n th\u01b0\u01a1ng CTO m\u1ea1ch v\u00e0nh th\u01b0\u1eddng g\u1eb7p, chi\u1ebfm kho\u1ea3ng 1\/3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ee5p m\u1ea1ch v\u00e0nh. Trong m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean 14.439 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ee5p m\u1ea1ch v\u00e0nh \u1edf 3 trung t\u00e2m \u1edf Canada, t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf 18,4% b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh m\u1ea1ch v\u00e0nh, 54% b\u1ec7nh nh\u00e2n c\u00f3 ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u ch\u1ee7 v\u00e0nh (Coronary Artery Bypass Graft – CABG) tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 tr\u00ean 10% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c PCI th\u00ec \u0111\u1ea7u trong NMCT c\u1ea5p ST ch\u00eanh l\u00ean.<\/p>\n
Ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i (Left Ventricular Ejection Fraction – LVEF) b\u00ecnh th\u01b0\u1eddng \u1edf h\u01a1n 50% b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO. 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p CTO g\u1eb7p \u1edf m\u1ea1ch v\u00e0nh ph\u1ea3i (Right Coronary Artery – RCA).<\/p>\n
L\u00c2M S\u00c0NG<\/h2>\n
T\u1ed5n th\u01b0\u01a1ng CTO c\u00f3 th\u1ec3 g\u1eb7p tr\u00ean nhi\u1ec1u b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau nh\u01b0:<\/p>\n
\n
\u0110au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 k\u00e8m tri\u1ec7u ch\u1ee9ng suy tim.<\/li>\n
H\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p tr\u00ean b\u1ec7nh nh\u00e2n b\u1ec7nh nhi\u1ec1u nh\u00e1nh m\u1ea1ch v\u00e0nh c\u00f3 k\u00e8m t\u1ed5n th\u01b0\u01a1ng CTO.<\/li>\n
NMCT t\u00edp 2 th\u1ee9 ph\u00e1t sau c\u01a1n nh\u1ecbp nhanh, suy h\u00f4 h\u1ea5p c\u1ea5p, m\u1ea5t m\u00e1u c\u1ea5p, sau ph\u1eabu thu\u1eadt ngo\u00e0i tim…<\/li>\n
Ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd qua ch\u1ee5p MSCT m\u1ea1ch v\u00e0nh ho\u1eb7c ki\u1ec3m tra g\u1eafng s\u1ee9c.<\/li>\n<\/ul>\n
TI\u1ebeP C\u1eacN B\u1ec6NH NH\u00c2N C\u00d3 T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n
Ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n<\/h3>\n
\u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng CTO lu\u00f4n l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c, c\u1ea7n c\u00f3 s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 khi t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh, do \u0111\u00f3 \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng v\u1ec1 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng nh\u01b0 ECG, si\u00eau \u00e2m tim, ki\u1ec3m tra h\u00ecnh \u1ea3nh h\u1ecdc g\u1eafng s\u1ee9c \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n
C\u00f3 nhi\u1ec1u h\u01b0\u1edbng d\u1eabn ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO m\u1ea1ch v\u00e0nh, trong \u0111\u00f3 theo \u0110\u1ed3ng thu\u1eadn n\u0103m 2024 c\u1ee7a H\u1ed9i Tim m\u1ea1ch can thi\u1ec7p ch\u00e2u \u00c2u (European Association of Percutaneous Cardiovascular Interventions – EAPCI), H\u1ed9i H\u00ecnh \u1ea3nh h\u1ecdc tim m\u1ea1ch ch\u00e2u \u00c2u (European Association of Cardiovascular Imaging – EACVI) v\u00e0 Nh\u00f3m c\u00f4ng t\u00e1c c\u1ee7a ESC v\u1ec1 Ph\u1eabu thu\u1eadt tim m\u1ea1ch, b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn theo S\u01a1 \u0111\u1ed3 1 nh\u01b0 sau:<\/p>\n
$\"S\u01a1$
S\u01a1 \u0111\u1ed3 1. Ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO.<\/figcaption><\/figure>\n
B\u1ec7nh nh\u00e2n tr\u1ebb, b\u1ec7nh nh\u00e2n t\u1eafc m\u1ea1n t\u00ednh \u0111o\u1ea1n g\u1ea7n \u0111\u1ed9ng m\u1ea1ch li\u00ean th\u1ea5t tr\u01b0\u1edbc, b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebfu m\u00e1u c\u01a1 tim \u0111\u00e1ng k\u1ec3 v\u00e0 v\u00f9ng c\u01a1 tim c\u00f2n s\u1ed1ng.
\nCCS: Canadian Cardiovascular Society; EQ-5D: European quality of life five-dimensions; RDS: Rose Dyspnea Scale; RLV\u0110: r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng; SAQ: Seattle Angina Questionnaire.<\/p>\n
Ti\u1ebfp c\u1eadn ban \u0111\u1ea7u<\/h3>\n
Ch\u1ec9 \u0111\u1ecbnh ch\u00ednh cho vi\u1ec7c t\u00e1i th\u00f4ng t\u1ed5n th\u01b0\u01a1ng CTO l\u00e0 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng khi g\u1eafng s\u1ee9c nh\u01b0 \u0111au ng\u1ef1c v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0 kh\u00f3 th\u1edf. Do \u0111\u00f3, kh\u00e1m l\u00e2m s\u00e0ng ban \u0111\u1ea7u \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u00e0 c\u1ea9n th\u1eadn v\u1ec1 tri\u1ec7u ch\u1ee9ng v\u00e0 s\u1ef1 thay \u0111\u1ed5i kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c so v\u1edbi nh\u1eefng th\u00e1ng tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
C\u00e1c thang \u0111i\u1ec3m c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n g\u1ed3m ph\u00e2n \u0111\u1ed9 \u0111au ng\u1ef1c theo CCS (xem Ph\u00e1c \u0111\u1ed3 37), b\u1ea3ng c\u00e2u h\u1ecfi Seattle (SAQ), ph\u00e2n \u0111\u1ed9 kh\u00f3 th\u1edf Rose tr\u00ean b\u1ec7nh nh\u00e2n b\u1ec7nh m\u1ea1ch v\u00e0nh (thang \u0111i\u1ec3m RDS B\u1ea3ng 1) v\u00e0 \u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng theo b\u1ed9 c\u00e2u h\u1ecfi EQ-5D (B\u1ea3ng 2).<\/p>\n
B\u1ea3ng 1. Ph\u00e2n \u0111\u1ed9 t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf theo thang \u0111i\u1ec3m RDS<\/p>\n\n\n\n\n\n\n\n\n
\u0110i\u1ec3m<\/td>\n Ch\u00fa th\u00edch<\/td>\n<\/tr>\n
0<\/td>\n Kh\u00f4ng kh\u00f3 th\u1edf.<\/td>\n<\/tr>\n
1<\/td>\n Kh\u00f3 th\u1edf khi \u0111i nhanh ho\u1eb7c leo \u0111\u1ed3i.<\/td>\n<\/tr>\n
2<\/td>\n Kh\u00f3 th\u1edf khi \u0111i b\u1ed9 v\u1edbi ng\u01b0\u1eddi c\u00f9ng tu\u1ed5i tr\u00ean \u0111\u01b0\u1eddng b\u1eb1ng ph\u1eb3ng.<\/td>\n<\/tr>\n
3<\/td>\n Kh\u00f3 th\u1edf khi \u0111i b\u1ed9 v\u1edbi v\u1eadn t\u1ed1c ri\u00eang tr\u00ean \u0111\u01b0\u1eddng b\u1eb1ng ph\u1eb3ng.<\/td>\n<\/tr>\n
4<\/td>\n Kh\u00f3 th\u1edf khi t\u1eafm r\u1eeda ho\u1eb7c m\u1eb7c qu\u1ea7n \u00e1o.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
B\u1ea3ng 2. \u0110\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng theo b\u1ed9 c\u00e2u h\u1ecfi EQ-5D (https:\/\/euroqol.org\/euroqol\/)<\/p>\n
B\u1ed8 C\u00c2U H\u1eceI EQ-SD-SL (Phi\u00ean b\u1ea3n ti\u1ebfng Vi\u1ec7t)<\/p>\n
$\"B\u1ed8$ <\/p>\n
\u0110\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh h\u1ecdc<\/h3>\n
\u0110\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh h\u1ecdc to\u00e0n di\u1ec7n \u1edf b\u1ec7nh nh\u00e2n CTO nh\u1eb1m m\u1ee5c \u0111\u00edch x\u00e1c \u0111\u1ecbnh gi\u1ea3i ph\u1eabu c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh li\u00ean quan, \u0111\u1ed9 r\u1ed9ng v\u00f9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a v\u00f9ng c\u01a1 tim \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 \u0111o\u00e1n hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c t\u00e1i th\u00f4ng t\u1ed5n th\u01b0\u01a1ng CTO v\u1edbi t\u00ecnh tr\u1ea1ng t\u00e1i c\u1ea5u tr\u00fac kh\u1ed1i c\u01a1 th\u1ea5t tr\u00e1i v\u00e0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u1ed3n l\u01b0u khi theo d\u00f5i.<\/p>\n
M\u1ed7i ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u1ec1u c\u00f3 \u01b0u \u0111i\u1ec3m v\u00e0 h\u1ea1n ch\u1ebf, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ri\u00eang l\u1ebb ho\u1eb7c k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p.<\/p>\n
C\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i<\/h4>\n
M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i l\u00e0 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 khi t\u00e1i th\u00f4ng t\u1ed5n th\u01b0\u01a1ng CTO v\u00ec c\u00e1c bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng t\u0103ng l\u00ean khi ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m.
\nSi\u00eau \u00e2m tim l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean do \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i. H\u01a1n n\u1eefa, si\u00eau \u00e2m tim c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m kh\u00e1c nh\u01b0 b\u1ec7nh van tim ho\u1eb7c ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n
V\u00f9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 s\u1ef1 s\u1ed1ng c\u00f2n c\u01a1 tim<\/h4>\n
Nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh h\u1ecdc kh\u00e1c nhau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00f9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 s\u1ef1 s\u1ed1ng c\u00f2n c\u01a1 tim. L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh t\u00f9y thu\u1ed9c v\u00e0o s\u1ef1 s\u1eb5n c\u00f3 t\u1ea1i ch\u1ed7 v\u00e0 kinh nghi\u1ec7m chuy\u00ean m\u00f4n c\u1ee7a ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n.<\/p>\n
B\u1ea3ng 3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 v\u00f9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 s\u1ef1 s\u1ed1ng c\u00f2n c\u01a1 tim<\/p>\n\n\n\n\n\n\n\n
<\/td>\n Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/td>\n Kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u01a1 tim<\/td>\n H\u1ea1n ch\u1ebf<\/td>\n<\/tr>\n
Si\u00eau \u00e2m tim<\/td>\n \n
\n
RLV\u0110 do stress dot o > 3 trong 17 v\u00f9ng c\u01a1 tim.<\/li>\n
Gi\u1ea3m t\u01b0\u1edbi m\u00e1u do stress tr\u00ean si\u00eau \u00e2m t\u01b0\u01a1ng ph\u1ea3n dot o > 3 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
Dobutamin li\u1ec1u th\u1ea5p th\u1ec3 d\u1ee5c c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p c\u1ea3i thi\u1ec7n RLV\u0110 \u1edf > 3 trong 17 v\u00f9ng.<\/li>\n
C\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ea3o ng\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u do stress ho\u1eb7c khi ngh\u1ec9 tr\u00ean si\u00eau \u00e2m t\u01b0\u01a1ng ph\u1ea3n \u1edf > 3 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
Ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh.<\/li>\n
Kh\u1ea3 n\u0103ng t\u00e1i l\u1eadp.<\/li>\n
\u0110\u1ed9 nh\u1ea1y khi \u0111\u00e1nh gi\u00e1 s\u1ed1ng c\u00f2n th\u1ea5p.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
MRI c\u01a1 tim<\/td>\n \n
\n
RLV\u0110 do stress \\mathfrak{sigma} >= 3 trong 16 v\u00f9ng c\u01a1 tim.<\/li>\n
Gi\u1ea3m t\u01b0\u1edbi m\u00e1u do stress b >= 2 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
Dobutamin li\u1ec1u th\u1ea5p\/th\u1ec3 d\u1ee5c c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p c\u1ea3i thi\u1ec7n RLV\u0110 \u1edf \u1edf \u2265 3 trong 16 v\u00f9ng.<\/li>\n
LGE xuy\u00ean th\u00e0nh < 25-50% j > 4 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
S\u1ef1 s\u1eb5n c\u00f3.<\/li>\n
M\u1ea5t th\u1eddi gian.<\/li>\n
Chi ph\u00ed cao.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
SPECT v\u00e0 PET<\/td>\n \n
\n
Gi\u1ea3m t\u01b0\u1edbi m\u00e1u do stress j > 10% kh\u1ed1i c\u01a1 tim.<\/li>\n
H\u00ecnh \u1ea3nh PET do thu\u1ed1c \u1edf > 3 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
S\u1ef1 h\u1ea5p th\u1ee5 FDG PET khi ngh\u1ec9 > 50%.<\/li>\n
S\u1ef1 h\u1ea5p th\u1ee5 201-T1 ho\u1eb7c Tc-99m SPECT khi ngh\u1ec9 > 50%.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
Ti\u1ebfp x\u00fac b\u1ee9c x\u1ea1 ion h\u00f3a.<\/li>\n
T\u1ed1n th\u1eddi gian.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
MSCT m\u1ea1ch v\u00e0nh<\/td>\n \n
\n
Gi\u1ea3m t\u01b0\u1edbi m\u00e1u do stress v\u1edbi c\u1ea3n quang.<\/li>\n
FFR-CT < 0,8<\/li>\n<\/ul>\n<\/td>\n
\n
\n
T\u01b0\u1edbi m\u00e1u xuy\u00ean th\u00e0nh < 75% \u1edf > 3 trong 17 v\u00f9ng.<\/li>\n<\/ul>\n<\/td>\n
\n
\n
Ti\u1ebfp x\u00fac b\u1ee9c x\u1ea1 ion h\u00f3a.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ghi ch\u00fa: FDG: Flourodeoxyglucose; FFR-CT: Fractional flow reserve computed tomography \u2013 Ph\u00e2n su\u1ea5t d\u1ef1 tr\u1eef m\u1ea1ch v\u00e0nh tr\u00ean CT; LGE: Late gadolinum enhancement – Ng\u1eafm gadolinum th\u00ec mu\u1ed9n; MSCT: Multi-slide computed tomography – Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh; MRI: Magnetic resonance imaging C\u1ed9ng h\u01b0\u1edfng t\u1eeb, PET: Positron emission tomography – Ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 positron; SPECT: Single-photon emission computed tomography \u2013 Ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 \u0111\u01a1n photon; RLV\u0110: r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng.<\/p>\n
T\u00c1I TH\u00d4NG T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n
L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p t\u1ea3i th\u00f4ng t\u1ed5n th\u01b0\u01a1ng CTO<\/h3>\n
H\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u00e2u \u00c2u 2018 v\u00e0 Hoa K\u1ef3 2021 v\u1ec1 t\u1ea3i th\u00f4ng m\u1ea1ch v\u00e0nh \u0111\u1ec1u khuy\u1ebfn c\u00e1o v\u1ec1 kh\u00e1i ni\u1ec7m \u201cHeart Team – Nh\u00f3m Tim m\u1ea1ch” bao g\u1ed3m c\u00e1c b\u00e1c s\u0129 n\u1ed9i tim m\u1ea1ch, tim m\u1ea1ch can thi\u1ec7p, ph\u1eabu thu\u1eadt tim, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 g\u00e2y m\u00ea h\u1ed3i s\u1ee9c \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng kh\u00e1c nhau. \u0110\u1eb7c bi\u1ec7t trong nh\u1eefng t\u00ecnh hu\u1ed1ng ph\u1ee9c t\u1ea1p nh\u01b0 nhi\u1ec1u b\u1ec7nh \u0111i k\u00e8m, l\u1edbn tu\u1ed5i, b\u1ec7nh th\u00e2n chung v\u00e0 3 nh\u00e1nh m\u1ea1ch v\u00e0nh, t\u1ed5n th\u01b0\u01a1ng CTO…<\/p>\n
\u0110\u1ec3 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh, ngo\u00e0i kh\u00eda c\u1ea1nh v\u1ec1 gi\u1ea3i ph\u1eabu (c\u1ea5u tr\u00fac m\u1ea1ch v\u00e0nh, m\u1ee9c \u0111\u1ed9 v\u00f4i h\u00f3a, kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn \u0111o\u1ea1n b\u1ecb t\u1eafc) v\u00e0 ch\u1ee9c n\u0103ng (t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u01a1 tim), c\u1ea7n xem x\u00e9t th\u00eam h\u1ed3 s\u01a1 l\u00e2m s\u00e0ng v\u00e0 mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n. Theo \u0110\u1ed3ng thu\u1eadn n\u0103m 2024 c\u1ee7a H\u1ed9i Tim m\u1ea1ch can thi\u1ec7p ch\u00e2u \u00c2u, H\u1ed9i H\u00ecnh \u1ea3nh h\u1ecdc tim m\u1ea1ch ch\u00e2u \u00c2u v\u00e0 Nh\u00f3m c\u00f4ng t\u00e1c c\u1ee7a ESC v\u1ec1 Ph\u1eabu thu\u1eadt tim m\u1ea1ch, l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p t\u1ea3i th\u00f4ng m\u1ea1ch v\u00e0nh cho b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb theo s\u01a1 \u0111\u1ed3 2 nh\u01b0 sau:<\/p>\n
$\"S\u01a1$
S\u01a1 \u0111\u1ed3 2. L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p t\u00e1i th\u00f4ng t\u1ed5n th\u01b0\u01a1ng CTO.<\/figcaption><\/figure>\n
CABG: coronary artery bypass grafting \u2013 Ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh; CT: computed tomography – Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh; C\u0110HA: Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh; EuroSCORE: European System for Cardiac Operative Risk Evaluation – Thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1 ph\u1eabu thu\u1eadt; GMHS: G\u00e2y m\u00ea h\u1ed3i s\u1ee9c; J-CTO: Japanese Multicenter CTO Registry; LAD: left anterior descending artery – \u0110\u1ed9ng m\u1ea1ch li\u00ean th\u1ea5t tr\u01b0\u1edbc; PTV: Ph\u1eabu thu\u1eadt vi\u00ean; STS: Society of Thoracic Surgeons; TMCT: tim m\u1ea1ch can thi\u1ec7p.<\/p>\n
\u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng PCI t\u1ed5n th\u01b0\u01a1ng CTO th\u00e0nh c\u00f4ng<\/h3>\n
T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong qu\u00e1 kh\u1ee9 x\u1ea5p x\u1ec9 70-80% v\u00e0 kh\u00f4ng ng\u1eebng t\u0103ng l\u00ean v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c d\u1ee5ng c\u1ee5, k\u1ef9 thu\u1eadt v\u00e0 chi\u1ebfn l\u01b0\u1ee3c m\u1edbi. C\u00e1c thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO th\u00e0nh c\u00f4ng g\u1ed3m J-CTO (H\u00ecnh 1) v\u00e0 PROGRESS-CTO (H\u00ecnh 2).<\/p>\n
Y\u1ebfu t\u1ed1 kh\u00f4ng thu\u1eadn l\u1ee3i khi can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO nh\u01b0 l\u00e0 kh\u00f4ng c\u00f3 m\u1ecfm c\u1ee5t, kh\u00f4ng c\u00f2n nh\u1eefng “r\u00e3nh m\u1ea1ch m\u00e1u” nh\u1ecf \u1edf gi\u1eefa ch\u1ed7 t\u1eafc m\u1ea1n t\u00ednh, t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh \u1edf ngay nh\u00e1nh b\u00ean ho\u1eb7c c\u00f3 tu\u1ea7n ho\u00e0n b\u1eafc c\u1ea7u t\u1eeb tr\u01b0\u1edbc ch\u1ed7 t\u1eafc \u0111\u1ebfn sau ch\u1ed7 t\u1eafc.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 1. Thang \u0111i\u1ec3m J-CTO \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng \u0111i d\u00e2y d\u1eabn can thi\u1ec7p qua t\u1ed5n th\u01b0\u01a1ng t\u1eafc th\u00e0nh c\u00f4ng trong v\u00f2ng 30 ph\u00fat.<\/figcaption><\/figure>\n
Thang \u0111i\u1ec3m J-CTO d\u1ef1 \u0111o\u00e1n kh\u1ea3 n\u0103ng \u0111i d\u00e2y d\u1eabn can thi\u1ec7p qua t\u1ed5n th\u01b0\u01a1ng t\u1eafc th\u00e0nh c\u00f4ng trong v\u00f2ng 30 ph\u00fat, d\u1ef1a v\u00e0o 5 \u0111\u1eb7c \u0111i\u1ec3m sau:<\/p>\n
\n
\u0110\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu ch\u1ed7 t\u1eafc \u0111\u1ea7u g\u1ea7n: m\u1ea1ch m\u00e1u h\u1eb9p d\u1ea7n, c\u00f3 m\u1ecfm c\u1ee5t ho\u1eb7c m\u1ea1ch m\u00e1u kh\u00f4ng c\u00f3 m\u1ecfm c\u1ee5t, n\u1eb1m c\u1ea1nh nh\u00e1nh b\u00ean?<\/li>\n
V\u00f4i h\u00f3a \u0111o\u1ea1n t\u1eafc m\u1ea1n t\u00ednh hay kh\u00f4ng?<\/li>\n
\u0110\u1ed9 g\u1eadp g\u00f3c \u0111o\u1ea1n t\u1eafc m\u1ea1n t\u00ednh: kh\u00f4ng g\u1eadp g\u00f3c hay g\u1eadp g\u00f3c > 45\u00b0?<\/li>\n
\u0110\u1ed9 d\u00e0i \u0111o\u1ea1n t\u1eafc m\u1ea1n t\u00ednh: < 20 mm hay \u2265 20 mm?<\/li>\n
\u0110\u00e3 t\u1eebng PCI th\u1ea5t b\u1ea1i hay kh\u00f4ng?<\/li>\n<\/ul>\n
Ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean thang \u0111i\u1ec3m J-CTO g\u1ed3m c\u00f3 t\u1ed5n th\u01b0\u01a1ng d\u1ec5 (0 \u0111i\u1ec3m), t\u1ed5n th\u01b0\u01a1ng trung b\u00ecnh (1 \u0111i\u1ec3m), t\u1ed5n th\u01b0\u01a1ng kh\u00f3 (2 \u0111i\u1ec3m), t\u1ed5n th\u01b0\u01a1ng r\u1ea5t kh\u00f3 (\u2265 3 \u0111i\u1ec3m).<\/p>\n
Nguy c\u01a1 bi\u1ebfn ch\u1ee9ng khi PCI t\u1ed5n th\u01b0\u01a1ng CTO cao h\u01a1n so v\u1edbi PCI t\u1ed5n th\u01b0\u01a1ng th\u00f4ng th\u01b0\u1eddng. Theo NCDR (National Cardiovascular Data Registry), nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh (MACE) l\u00e0 kho\u1ea3ng 1,6% \u1edf PCI CTO so v\u1edbi 0,8% \u1edf PCI non-CTO. C\u00f3 nh\u1eefng thang \u0111i\u1ec3m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng khi PCI CTO nh\u01b0 thang \u0111i\u1ec3m bi\u1ebfn ch\u1ee9ng PROGRESS-CTO.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 2. Thang \u0111i\u1ec3m bi\u1ebfn ch\u1ee9ng PROGRESS-CTO \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n nguy c\u01a1 bi\u1ebfn ch\u1ee9ng quanh th\u1ee7 thu\u1eadt khi P\u0421\u0406 \u0421\u0422\u041e.<\/figcaption><\/figure>\n
CAN THI\u1ec6P T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n
Kh\u00e1ng \u0111\u00f4ng khi can thi\u1ec7p<\/h3>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n.<\/p>\n
M\u1ee5c ti\u00eau gi\u1eef ACT (Activated Clotting Time) > 300 gi\u00e2y khi PCI CTO xu\u00f4i d\u00f2ng v\u00e0 > 350 gi\u00e2y khi PCI CTO ng\u01b0\u1ee3c d\u00f2ng.<\/p>\n
\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng<\/h3>\n
C\u00e1c th\u00f4ng s\u1ed1 h\u00ecnh \u1ea3nh ch\u00ednh c\u1ea7n \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO bao g\u1ed3m:<\/p>\n
\n
\u0110\u1ea7u t\u1eadn \u0111o\u1ea1n g\u1ea7n (proximal cap) v\u00e0 m\u1ea1ch m\u00e1u \u0111o\u1ea1n g\u1ea7n.<\/li>\n
\u0110\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng (\u0111\u1ed9 d\u00e0i ngo\u1eb1n ngo\u00e8o v\u00f4i h\u00f3a).<\/li>\n
M\u1ea1ch m\u00e1u \u0111o\u1ea1n xa.<\/li>\n
Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7.<\/li>\n<\/ul>\n
Nh\u1eefng th\u00f4ng s\u1ed1 n\u00e0y s\u1ebd gi\u00fap \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u t\u1ed5n th\u01b0\u01a1ng CTO, \u0111\u01b0\u1eddng \u0111i v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng, \u0111i\u1ec3m k\u1ebft th\u00fac c\u1ee7a t\u1ed5n th\u01b0\u01a1ng v\u00e0 kh\u1ea3 n\u0103ng can thi\u1ec7p ng\u01b0\u1ee3c d\u00f2ng t\u1eeb \u0111\u1ea7u t\u1eadn \u0111o\u1ea1n xa (distal cap).<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 3. C\u00e1c th\u00f4ng s\u1ed1 h\u00ecnh \u1ea3nh ch\u00ednh c\u1ea7n \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi can thi\u1ec7p CTO.<\/figcaption><\/figure>\n
\u0110\u01b0\u1eddng ti\u1ebfp c\u1eadn<\/h3>\n
Ti\u1ebfp c\u1eadn b\u1eb1ng 2 \u0111\u01b0\u1eddng v\u00e0 b\u01a1m c\u1ea3n quang k\u00e9p (dual injection – ch\u1ee5p \u0111\u1ed3ng th\u1eddi m\u1ea1ch v\u00e0nh tr\u00e1i v\u00e0 ph\u1ea3i) l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01a1n gi\u1ea3n v\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t \u0111\u1ec3 t\u0103ng kh\u1ea3 n\u0103ng th\u00e0nh c\u00f4ng v\u00e0 gi\u1ea3m bi\u1ebfn ch\u1ee9ng khi can thi\u1ec7p CTO, n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean t\u1ea5t c\u1ea3 CTO c\u00f3 tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 \u0111\u1ed1i b\u00ean, ngay c\u1ea3 khi ch\u1ec9 can thi\u1ec7p xu\u00f4i d\u00f2ng.<\/p>\n
Vai tr\u00f2 c\u1ee7a b\u01a1m c\u1ea3n quang k\u00e9p gi\u00fap \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c h\u01a1n c\u1ee7a \u0111\u1ed9 d\u00e0i v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng CTO, th\u1ea5y \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed \u0111\u1ea7u d\u00e2y d\u1eabn can thi\u1ec7p khi can thi\u1ec7p xu\u00f4i d\u00f2ng, gi\u1ea3m t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u (d\u01b0\u1edbi n\u1ed9i m\u1ea1c) khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt reentry.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 4. V\u00ed d\u1ee5 v\u1ec1 vai tr\u00f2 c\u1ee7a b\u01a1m c\u1ea3n quang k\u00e9p khi can thi\u1ec7p CTO nh\u00e1nh m\u0169.
(A): Ch\u1ec9 b\u01a1m c\u1ea3n quang v\u00e0o th\u00e2n chung; (B): B\u01a1m c\u1ea3n quang k\u00e9p v\u00e0o th\u00e2n chung v\u00e0 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i.<\/figcaption><\/figure>\n
Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p<\/h3>\n
C\u00f3 nhi\u1ec1u chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO, trong \u0111\u00f3, chi\u1ebfn l\u01b0\u1ee3c s\u1eedd\u1ee5ng k\u1ef9 thu\u1eadt PCI xu\u00f4i d\u00f2ng s\u1eed d\u1ee5ng d\u00e2y d\u1eabn c\u00f3 \u0111\u1ed9 c\u1ee9ng t\u0103ng d\u1ea7n (Antegrade Wire Escalation) l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01a1n gi\u1ea3n v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u00edt nh\u1ea5t 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p PCI CTO hi\u1ec7n nay. S\u1ef1 quen thu\u1ed9c v\u00e0 t\u1ef1 tin khi th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt n\u00e0y t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho c\u00e1c k\u1ef9 thu\u1eadt kh\u00e1c nh\u01b0 can thi\u1ec7p g\u00e2y b\u00f3c t\u00e1ch v\u00e0 v\u00e0o l\u1ea1i (dissection-reentry) xu\u00f4i d\u00f2ng ho\u1eb7c ng\u01b0\u1ee3c d\u00f2ng.<\/p>\n
$\"S\u01a1$
S\u01a1 \u0111\u1ed3 3. L\u1ef1a ch\u1ecdn k\u1ef9 thu\u1eadt can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO.<\/figcaption><\/figure>\n
K\u1ef9 thu\u1eadt PCI xu\u00f4i d\u00f2ng s\u1eed d\u1ee5ng d\u00e2y d\u1eabn c\u00f3 \u0111\u1ed9 c\u1ee9ng t\u0103ng d\u1ea7n \u00e1p d\u1ee5ng t\u1ed1t nh\u1ea5t cho t\u1ed5n th\u01b0\u01a1ng c\u00f3 \u0111o\u1ea1n t\u1eafc ng\u1eafn < 20 mm, \u0111o\u1ea1n t\u1eafc d\u00e0i v\u1edbi m\u1ea1ch m\u00e1u th\u1eb3ng ho\u1eb7c c\u00f3 c\u00e1c vi m\u1ea1ch b\u00e0ng h\u1ec7, nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u00e1i h\u1eb9p trong stent c\u00f3 ch\u1ecdn l\u1ecdc.<\/p>\n
D\u1ee5ng c\u1ee5 can thi\u1ec7p<\/h3>\n
D\u1ee5ng c\u1ee5 khi can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO g\u1ed3m nh\u1eefng d\u1ee5ng c\u1ee5 t\u01b0\u01a1ng t\u1ef1 khi can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng th\u00f4ng th\u01b0\u1eddng kh\u00e1c v\u00e0 m\u1ed9t s\u1ed1 d\u1ee5ng c\u1ee5 \u0111\u1eb7c bi\u1ec7t nh\u01b0 \u1ed1ng th\u00f4ng can thi\u1ec7p c\u00f3 \u0111\u1ed9 h\u1ed7 tr\u1ee3 t\u1ed1t, v\u00ec \u1ed1ng th\u00f4ng, d\u00e2y d\u1eabn can thi\u1ec7p c\u1ee9ng…<\/p>\n
\u00d4ng th\u00f4ng can thi\u1ec7p (guiding catheter)<\/h4>\n
\u00d4ng th\u00f4ng can thi\u1ec7p c\u00f3 \u0111\u1ed9 h\u1ed7 tr\u1ee3 t\u1ed1t r\u1ea5t c\u1ea7n thi\u1ebft khi can thi\u1ec7p CTO, b\u1ea5t k\u1ec3 k\u1ef9 thu\u1eadt \u0111i d\u00e2y d\u1eabn can thi\u1ec7p n\u00e0o \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn.<\/p>\n
\u0110\u1ec3 t\u0103ng \u0111\u1ed9 h\u1ed7 tr\u1ee3 c\u1ee7a \u1ed1ng th\u00f4ng can thi\u1ec7p, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n nh\u1eefng c\u00e1ch l\u00e0m nh\u01b0 sau:<\/p>\n
\n
S\u1eed d\u1ee5ng \u1ed1ng th\u00f4ng k\u00edch th\u01b0\u1edbc l\u1edbn: 7 F, 8 F.<\/li>\n
S\u1eed d\u1ee5ng \u1ed1ng th\u00f4ng h\u1ed7 tr\u1ee3 \u0111\u1eb7c bi\u1ec7t: \u1ed1ng th\u00f4ng AL (can thi\u1ec7p CTO m\u1ea1ch v\u00e0nh ph\u1ea3i), \u1ed1ng th\u00f4ng EBU (can thi\u1ec7p CTO m\u1ea1ch v\u00e0nh tr\u00e1i)…<\/li>\n
K\u1ef9 thu\u1eadt “deep seating” \u1ed1ng th\u00f4ng can thi\u1ec7p ho\u1eb7c d\u00f9ng th\u00eam “buddy wire”.<\/li>\n
S\u1eed d\u1ee5ng \u1ed1ng th\u00f4ng can thi\u1ec7p n\u1ed1i d\u00e0i (guiding extension).<\/li>\n<\/ul>\n
$\"H\u00ecnh$
H\u00ecnh 5. C\u00e1c k\u1ef9 thu\u1eadt t\u0103ng l\u1ef1c h\u1ed7 tr\u1ee3 cho guiding catheter.<\/figcaption><\/figure>\n
Vi \u1ed1ng th\u00f4ng can thi\u1ec7p (microcatheter)<\/h4>\n
V\u00ec \u1ed1ng th\u00f4ng can thi\u1ec7p hay b\u00f3ng over-the-wire n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho t\u1ea5t c\u1ea3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng CTO, trong \u0111\u00f3 v\u00ec \u1ed1ng th\u00f4ng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng h\u01a1n v\u00ec l\u00e0m t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng \u0111\u00e2m xuy\u00ean; cho ph\u00e9p t\u00e1i \u0111\u1ecbnh h\u00ecnh \u0111\u1ea7u tip d\u00e2y d\u1eabn hay d\u1ec5 d\u00e0ng thay \u0111\u1ed5i d\u00e2y d\u1eabn m\u00e0 kh\u00f4ng l\u00e0m m\u1ea5t v\u1ecb tr\u00ed c\u1ee7a d\u00e2y, ng\u0103n ng\u1eeba kh\u1ea3 n\u0103ng xo\u1eafn wire trong k\u1ef9 thu\u1eadt 2 d\u00e2y d\u1eabn song song.<\/p>\n
C\u00e1c lo\u1ea1i vi \u1ed1ng th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 Corsair, Caravel, Finecross, Crusade… t\u00f9y \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng CTO v\u00e0 s\u1ef1 s\u1eb5n c\u00f3.<\/p>\n
D\u00e2y d\u1eabn (guidewire) can thi\u1ec7p<\/h4>\n
L\u1ef1a ch\u1ecdn d\u00e2y d\u1eabn c\u1ee9ng ph\u00f9 h\u1ee3p t\u00f9y thu\u1ed9c \u0111\u1eb7c \u0111i\u1ec3m t\u1eebng lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng CTO v\u00e0 kinh nghi\u1ec7m c\u0169ng nh\u01b0 s\u1ef1 quen thu\u1ed9c c\u1ee7a t\u1eebng b\u00e1c s\u0129 can thi\u1ec7p \u0111\u1ed1i v\u1edbi d\u00e2y d\u1eabn.<\/p>\n
C\u00e1c d\u00e2y d\u1eabn can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO g\u1ed3m c\u00f3 d\u00e2y d\u1eabn “\u00e1i n\u01b0\u1edbc” (hydrophilic wire); d\u00e2y d\u1eabn \u0111\u1ea7u nh\u1ecf d\u1ea7n (Cross-IT, Conquest, Miracle); d\u00e2y d\u1eabn “khoan xuy\u00ean ch\u1ed7 t\u1eafc” (Abbott PROGRESS 140T, 200T, Asahi Confienza, Medtronic PROVIA); d\u00e2y d\u1eabn ph\u1ee7 polymer gi\u00fap tr\u01b0\u1ee3t t\u1ed1t trong t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh (Abbott PILOT v\u00e0 WHISPER, Asahi Fielder FC v\u00e0 XT, Abbott PROGRESS 40,80); d\u00e2y d\u1eabn gi\u00fap “lu\u1ed3n l\u00e1ch\u201d qua nh\u1eefng r\u00e3nh r\u1ea5t nh\u1ecf trong t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh (Gaia), d\u00e2y d\u1eabn \u0111i qua tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 (SION Blue ES, RG 3)…<\/p>\n
BI\u1ebeN CH\u1ee8NG KHI CAN THI\u1ec6P T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n
Ph\u00e2n lo\u1ea1i theo th\u1eddi gian (c\u1ea5p t\u00ednh v\u00e0 d\u00e0i h\u1ea1n) v\u00e0 theo v\u1ecb tr\u00ed bi\u1ebfn ch\u1ee9ng (m\u1ea1ch v\u00e0nh, tim m\u1ea1ch ngo\u00e0i m\u1ea1ch v\u00e0nh v\u00e0 ngo\u00e0i tim m\u1ea1ch).<\/p>\n
Bi\u1ebfn ch\u1ee9ng c\u1ea5p<\/h3>\n
Nh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ea5p c\u00f3 th\u1ec3 g\u1eb7p khi PCI t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong S\u01a1 \u0111\u1ed3 4.<\/p>\n
Bi\u1ebfn ch\u1ee9ng d\u00e0i h\u1ea1n<\/h3>\n
C\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ec1 d\u00e0i h\u1ea1n c\u00f3 th\u1ec3 g\u1eb7p khi can thi\u1ec7p t\u1ed5n th\u01b0\u01a1ng CTO c\u0169ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u1ea3i CTO kh\u00e1c bao g\u1ed3m huy\u1ebft kh\u1ed1i trong stent, t\u00e1i h\u1eb9p trong stent, ph\u00ecnh b\u00f3c t\u00e1ch m\u1ea1ch v\u00e0nh mu\u1ed9n…<\/p>\n
$\"S\u01a1$
S\u01a1 \u0111\u1ed3 4. Ph\u00e2n lo\u1ea1i bi\u1ebfn ch\u1ee9ng c\u1ea5p t\u00ednh khi PCI \u0421\u0422\u041e.<\/figcaption><\/figure>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
\n
Galassi AR et al. Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. EuroIntervention 2024:20:e174-e184.<\/li>\n
Brilakis E et al (2018). Manual of Chronic Total Occlusion Interventions, A Step-by-Step Approach 2nd edition. Elsevier, London.<\/li>\n
Neumann FJ et al. ESC\/EACTS Guidelines on myocardial revascularization. Eur Heart J 2018:00:1-96.<\/li>\n
Lawton JS et al. 2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;145:e4-17.<\/li>\n
Topol EJ and Teirstein PS (2016). Chapter 25: Intervention for Coronary Chronic Total Occlutions. In: Topol EJ and Teirstein PS, Textbook of Interventional Cardiology 7th edition. ELSEVIER, Philadelphia, pp.413-423.<\/li>\n
Thach Nguyen (ed) (2013). Chapter 10: Chronic Total Occlusion. In: Thach Nguyen, Practical Handbook of Advanced Interventional Cardiology Tips and Tricks. John Wiley & Sons. West Sussex, pp.207-254.<\/li>\n
Bhatt DL (ed) (2016). Chapter 9: Chronic Total Coronary Occlusions: Rationale, Technique, and Clinical Outcomes. In: Bhatt DL, Cardiovascular Intervention A Companion to Braunwald’s Heart Disease. Elsevier. Philadelphia, pp. 138-154.<\/li>\n
Kern MJ and Seto AH (2018). Chapter 26: Chronic Total Occlusion Percutaneous Coronary Intervention. In: Kern MJ and Seto AH, SCAI Interventional Cardiology Review 3d editon. Wolters Kluver, Philadelphia, pp.831-852.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Xem v\u00e0 t\u1ea3i file PDF T\u1ea0I \u0110\u00c2Y. M\u1ede \u0110\u1ea6U Hi\u1ec7n nay t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1ea1n t\u00ednh m\u1ea1ch v\u00e0nh (Chronic Total Occlusion CTO) kh\u00e1 th\u01b0\u1eddng g\u1eb7p v\u00e0 xu\u1ea5t hi\u1ec7n trong nhi\u1ec1u b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau. \u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng CTO l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng v\u00e0 k\u1ef9 thu\u1eadt, \u0111\u00f2i h\u1ecfi s\u1ef1 […]\n","protected":false},"author":1,"featured_media":155643,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-155631","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/155631","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=155631"}],"version-history":[{"count":4,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/155631\/revisions"}],"predecessor-version":[{"id":155648,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/155631\/revisions\/155648"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/155643"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=155631"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=155631"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=155631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

TI\u1ebeP C\u1eacN B\u1ec6NH NH\u00c2N C\u00d3 T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n

T\u00c1I TH\u00d4NG T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n

CAN THI\u1ec6P T\u1ed4N TH\u01af\u01a0NG T\u00c1C M\u1ea0N T\u00cdNH<\/h2>\n

Bi\u1ebfn ch\u1ee9ng c\u1ea5p<\/h3>\nNh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ea5p c\u00f3 th\u1ec3 g\u1eb7p khi PCI t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong S\u01a1 \u0111\u1ed3 4.<\/p>\n

Bi\u1ebfn ch\u1ee9ng c\u1ea5p<\/h3>\n
Nh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ea5p c\u00f3 th\u1ec3 g\u1eb7p khi PCI t\u1ed5n th\u01b0\u01a1ng CTO \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong S\u01a1 \u0111\u1ed3 4.<\/p>\n