Richard Heuser教授 美国圣卢克医疗中心

　　<International Circulation>: Chronic total occlusion (CTO) which has low surgical success rate and high restenosis or re-occlusion rate is one difficulty of intervention. Would you please talk about the new progress of the techniques and methods in terms of the treatment of CTO?

　　Prof. Heuser: In terms of peripheral CTOs， the problem with peripheral vascular disease is that the majority of patients with symptomatic peripheral vascular disease will have at least a short occlusion. The nice thing is that current technology， including hydrophilic wires， some committed crossing devices， are effective， in over 90 percent of chronic total occlusions in the superficial femoral artery， popliteal (artery) and below. The technology is there， the success rate is very high. The question is， how can you safely do it as well as how can you do it without comprising flow distally. This is an important thing and also， there are two groups， one of the claudicants and the other group is patients with critical leg ischemia (CLI). The success rate can still be over 90 percent in both groups， however.

　　《国际循环》：慢性完全闭塞病变（CTO）手术成功率低、并发症及再狭窄/再闭塞率高，是介入治疗的难点。您能否介绍一下近年来CTO病变的治疗在技术和方法上取得了哪些新进展？

　　Heuser教授：就外周CTO而言，外周血管疾病的问题在于大多数有症状的外周血管疾病患者至少都存在短期闭塞。幸运的是，目前的技术包括亲水涂层导丝以及交叉设备都非常有效，且90%以上的CTO病变发生于股浅动脉、腘动脉甚至更远端。有了上述很好的技术，CTO病变治疗的成功率已非常高。现在的问题是，如何安全实施以及如何在不影响远端血流的情况下实施。这对周围闭塞性疾病跛行及伴严重肢体缺血患者而言是非常重要的，在上述两种患者中治疗成功率可达90%以上。

　　<International Circulation>: For the treatment of peripheral vascular disease (PAD)， what are the updates of the latest European and American guidelines? What are the indications of endovascular intervention? How do you think about its role in the treatment of PAD?

　　Prof. Heuser: Even in task 3， the most difficult lesions， most vascular surgeons and certainly busy interventional radiologists， busy interventional cardiologists will propose endovascular first in virtually all lesions. It’s a situation where if failure occurs， either restenosis or thrombosis， a surgical option is a secondary option. Usually， it’s intervention first.

　　《国际循环》：就外周血管疾病（PAD）的治疗而言，欧美的最新指南做了哪些重要更新？血管内介入治疗的适应证有哪些？我们应如何看待血管内介入治疗在PAD治疗中的地位？

　　Heuser教授：ACCF/AHA最新发布的第三版指南中，大多数血管外科医生、忙碌的介入放射学家及介入心脏病学家都支持几乎所有病变包括最棘手的病变都可首先进行血管内介入治疗。如果血管内介入治疗后发生再狭窄或血栓形成导致治疗失败，则可将手术治疗作为第二选择。通常情况下应首选血管内介入治疗。

　　<International Circulation>: As we know， you conducted a preclinical study about single electrode through the pelvis of radiofrequency catheter ablation of resistant hypertension. What results you have gotten? What do you think are the main mechanisms and clinic indications of this non-vascular system for treating resistant hypertension? How do you think about its application prospects?

　　Prof. Heuser: Basically， what we have proposed is the biggest， hottest thing in internal medicine these days—the treatment of hypertension with renal denervation. Many investigators have approached this in an intra-arterial manner because the nerves run parallel to the arteries， but there are a lot of other innervations of the kidneys. In fact， from work done by real experts in this field， not myself， we have found out that there are a plethora of nerves in the renal collecting system， particularly in the renal pelvis. What we uniquely found out about them is that there is a much wider abundance of afferent nerves – afferent nerves are the ones that go up from the kidney to the brain – and are very much involved in this central， symptomatic tone. So， our concept is that we treat through the urethra and up the ureter and into the collecting system， with energy applied to the pelvis. What is very unique about it， and we’ve done this and seen in this in our sheep， as well as pigs， is that the nerves are very superficial to the pelvis. So， we think we can apply not-very-high energy for a very short duration. But we are doing our preclinical studies to freeze the design and we will be reporting our clinical results shortly， probably in the spring of this next year.

　　《国际循环》：据我们所知，您开展了一项有关经肾盂单电极导管射频消融治疗顽固性高血压的临床前研究。这项研究的结果如何？这种非血管系统治疗顽固性高血压的机制及适应证是什么？其应用前景如何？

　　Heuser教授：基本上，最近内科学领域所提最多和最热门的话题是去肾脏交感神经治疗。很多研究者都已开始采用动脉内的方式开展这项治疗，因为神经的走行与动脉平行。但也有很多针对肾脏的其他治疗方法。通过很多这一领域权威专家的研究成果，我们发现肾集合系统尤其是肾盂中存在大量神经，这其中富含大量从肾脏传入大脑的传入神经，这些神经参与了高血压的发病。因而我们认为，通过尿道和输尿管进入肾集合系统将射频能量释放至肾盂以达治疗高血压目的。我们在猪及羊的动物模型中已发现，这些神经位于肾盂非常浅表的部位。所以，采用并不非常高的能量进行短期射频即能达到治疗作用。目前我们正在开展临床前研究，可能将于明年春天公布临床结果。