8th Experts Live CTO Workshop 2016, September, 30th - October 1st, 2016 in Krakow, Poland

1. Is chronic total occlusion
a step in atherosclerosis natural progression
or more?
Tomasz J. Guzik

3. What Should We Know About Prevented, Diagnostic, and Interventional Therapy in Coronary Artery
Disease", book edited by Branislav G. Baskot

4. Media
Media
Neointima
Neointima
Loose connective tissue
Sclerotic connective tissue
Calcification
Calcification
Loose connective tissue
Thrombus
Neovasculature
Neovasculature
Cholesterol crystals
PVAT PVAT
Calcification

5. Katsuragawa et al:
Srivatsa et al, 1997, JACC

6. Atherosclerosis starts early… maybe early
start is a risk factor for TCO?
New Engl J Med, 1998

7. New Engl J Med, 1998

8. How does atherosclerotic plaque appear?

10. Good endothelial function
Dysfunctional endothelium
NO PGI2 CNP EDHF
ET PGH2 O2
- TXA2
Risk factors for atherosclerosis
Endothelial Dysfunction
Guzik et al, Circulation, 2002

11. Starting point ACh
4 years later
NTG
Schachinger, Circulation, 2000
Constriction
Instead of
relaxation

16. Srivatsa et al, 1997, JACC
Plaque evolution

17. Sakakura et al., Int Cardiovasc Res J.2016;10(2):55-60

18. But…
Guzik et al, Thrombosis and Haemostasis, 2013

19. Is CTO pathogenesis a consequence of
„chronic plaque indtability”
Neovascula-
rization

20. Central vascular channels
Srivatsa et al, 1997, JACC

21. Plaque composition

22. CTO Inflammation score
Srivatsa et al, 1997, JACC
Sagan, Thrombosis&Hemostasis, 2016

23. Will it be a chronic consequence of plaque stabilization?

24. Fibro-calcified Calcified
Srivatsa et al, 1997, JACC

25. Trends in Cardiovascular Medicine, 2014
CTO Biomarkers?
Mikro RNA

26. Libby&PlutzkyCirculation2002