{"id":4415,"date":"2024-01-22T08:38:20","date_gmt":"2024-01-22T08:38:20","guid":{"rendered":"https:\/\/ambercell.pixel-dev.lt\/koronaras-intervences\/"},"modified":"2025-04-15T13:53:17","modified_gmt":"2025-04-15T13:53:17","slug":"koronaras-intervences","status":"publish","type":"page","link":"https:\/\/ambercell.eu\/lv\/arstiem\/sirds-un-asinsvadu-slimibas\/koronaras-intervences\/","title":{"rendered":"Koron\u0101r\u0101s intervences"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4415\" class=\"elementor elementor-4415 elementor-1884\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-64b2c50 e-flex e-con-boxed e-con e-parent\" data-id=\"64b2c50\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6f9ea7f elementor-widget elementor-widget-template\" data-id=\"6f9ea7f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"page\" data-elementor-id=\"10690\" class=\"elementor elementor-10690 elementor-10684 elementor-10684\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6b29e20c e-flex e-con-boxed e-con e-parent\" data-id=\"6b29e20c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-43c192b1 e-con-full e-flex e-con e-child\" data-id=\"43c192b1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-11d26cc6 e-flex e-con-boxed e-con e-child\" data-id=\"11d26cc6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-2be2c9cc e-flex e-con-boxed e-con e-child\" data-id=\"2be2c9cc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-30ebd22 elementor-widget elementor-widget-spacer\" data-id=\"30ebd22\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6fd3f1d2 elementor-widget elementor-widget-text-editor\" data-id=\"6fd3f1d2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Hroniska piln\u012bg\u0101 okl\u016bzija (CTO) ir viena no sare\u017e\u0123\u012bt\u0101kaj\u0101m un kl\u012bniski noz\u012bm\u012bg\u0101kaj\u0101m koron\u0101r\u0101s iejauk\u0161an\u0101s jom\u0101m. Tas notiek, kad koron\u0101r\u0101 art\u0113rija ir piln\u012bb\u0101 blo\u0137\u0113ta vismaz tr\u012bs m\u0113ne\u0161us, nov\u0113r\u0161ot asins pl\u016bsmu uz skarto sirds da\u013cu. \u0160is asinsrites tr\u016bkums at\u0146em sirdij sk\u0101bekli un bar\u012bbas vielas, izraisot stenokardiju. TO ir l\u012bdz pat 30% pacientu ar koron\u0101ro art\u0113riju slim\u012bbu <strong>[1]<\/strong> V\u0113sturiski \u0161ie gad\u012bjumi tika uzskat\u012bti par tehniski sare\u017e\u0123\u012btiem un gr\u016bti \u0101rst\u0113jamiem, izmantojot invaz\u012bvas metodes. Tom\u0113r perkut\u0101no meto\u017eu un specializ\u0113to iek\u0101rtu sasniegumi ir iev\u0113rojami uzlaboju\u0161i rezult\u0101tus. Procesu\u0101lie riski, kas saist\u012bti ar CTO perkut\u0101no koron\u0101ro iejauk\u0161anos (PCI), ir past\u0101v\u012bgi samazin\u0101ju\u0161ies pieredz\u0113ju\u0161os centros <strong>[0] <\/strong>Jaun\u0101kie notikumi intervences kardiolo\u0123ij\u0101 un jaun\u0101s CTO \u0101rst\u0113\u0161anas strat\u0113\u0123ij\u0101s ir izrais\u012bju\u0161i augst\u0101kus pan\u0101kumu r\u0101d\u012bt\u0101jus, uzlabotu pacientu dz\u012bvildzi un lab\u0101ku dz\u012bves kvalit\u0101ti. Jaun\u0101kie dati no CTO pieredz\u0113ju\u0161\u0101m vietn\u0113m ASV liecina par tehnisko pan\u0101kumu r\u0101d\u012bt\u0101jiem &gt; 90%.<strong>\u0160aj\u0101<\/strong> l\u0113mum\u0101 Komisija uzskata, ka      <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5e540974 elementor-widget elementor-widget-image\" data-id=\"5e540974\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"529\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/The-components-of-chronic-total-occlusion-CTO-lesions-1.webp\" class=\"attachment-large size-large wp-image-10585\" alt=\"\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/The-components-of-chronic-total-occlusion-CTO-lesions-1.webp 893w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/The-components-of-chronic-total-occlusion-CTO-lesions-1-300x198.webp 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/The-components-of-chronic-total-occlusion-CTO-lesions-1-768x507.webp 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Hroniskas kop\u0113j\u0101s okl\u016bzijas (CTO) boj\u0101jumu sast\u0101vda\u013cas [30]<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-11b7a8b6 e-flex e-con-boxed e-con e-parent\" data-id=\"11b7a8b6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-205e9891 e-con-full e-flex e-con e-child\" data-id=\"205e9891\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2f3a6cbc elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"2f3a6cbc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-35473e84 e-flex e-con-boxed e-con e-child\" data-id=\"35473e84\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-31a3c750 elementor-hidden-mobile e-flex e-con-boxed e-con e-child\" data-id=\"31a3c750\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-56c20144 elementor-widget elementor-widget-heading\" data-id=\"56c20144\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Kas ir CTO PCI?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1957662 e-flex e-con-boxed e-con e-child\" data-id=\"1957662\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1154ac39 elementor-widget elementor-widget-text-editor\" data-id=\"1154ac39\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Agr\u0101k pacientiem ar CTO, kuriem bija stenokardija (s\u0101pes kr\u016bt\u012bs, elpas tr\u016bkums, nogurums), neskatoties uz optim\u0101lu medic\u012bnisko terapiju, bija nepiecie\u0161ama atv\u0113rtas sirds oper\u0101cija &#8211; koron\u0101ro art\u0113riju apvedce\u013ca transplant\u0101cija (CABG). M\u016bsdien\u0101s CTO var \u0101rst\u0113t, izmantojot minim\u0101li invaz\u012bvu metodi, ko sauc par perkut\u0101no koron\u0101ro iejauk\u0161anos (PCI). \u0160\u012b proced\u016bra ietver art\u0113rijas atv\u0113r\u0161anu ar baloniem, stentiem un specializ\u0113tu apr\u012bkojumu. Nep\u0101rtraukta pa\u0146\u0113mienu, apr\u012bkojuma un specializ\u0113t\u0101s apm\u0101c\u012bbas att\u012bst\u012bba ir palielin\u0101jusi pan\u0101kumu r\u0101d\u012bt\u0101jus, padarot CTO PCI par paredzamu un efekt\u012bvu \u0101rst\u0113\u0161anu. Eiropas vadl\u012bnijas miokarda revaskulariz\u0101cijai iesaka CTO PCI, lai samazin\u0101tu i\u0161\u0113miju skartaj\u0101 miokarda teritorij\u0101 un mazin\u0101tu stenokardijas simptomus <strong>[2].<\/strong>             <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-648b346b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"648b346b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7344f936 e-flex e-con-boxed e-con e-parent\" data-id=\"7344f936\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-67775f2b e-con-full e-flex e-con e-child\" data-id=\"67775f2b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1eee0eba elementor-widget elementor-widget-heading\" data-id=\"1eee0eba\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pacientu izv\u0113le<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-75a1d04f elementor-widget elementor-widget-text-editor\" data-id=\"75a1d04f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Izmantojot m\u016bsdien\u012bgas metodes un apr\u012bkojumu, pacientu izv\u0113lei nevajadz\u0113tu pa\u013cauties tikai uz boj\u0101juma veidu (kop\u0113jo, subkop\u0113jo vai stipri obstrukt\u012bvu), bet koncentr\u0113ties uz simptomiem un diagnostikas atkl\u0101jumiem [3].  <br>Pa\u0161reiz\u0113j\u0101 ekspertu vienpr\u0101t\u012bba uzsver \u010detras galven\u0101s CTO PCI indik\u0101cijas:<\/p><ol><li>Dz\u012bvesveidu ierobe\u017eojo\u0161o simptomu mazin\u0101\u0161ana un uzlabota fizisk\u0101s slodzes sp\u0113ja.<\/li><li>Neinvaz\u012bv\u0101s test\u0113\u0161anas laik\u0101 konstat\u0113t\u0101 i\u0161\u0113misk\u0101 slodzes samazin\u0101\u0161ana.<\/li><li>Aizdusa, kas saist\u012bta ar kreis\u0101 kambara (LV) disfunkciju, ar dz\u012bvotsp\u0113j\u012bgu miokarda pier\u0101d\u012bjumiem.<\/li><li>Ilgtermi\u0146a prognozes uzlabo\u0161ana pacientiem ar augsta riska, daudzasinsvadu koron\u0101ro art\u0113riju slim\u012bbu (CAD) <strong>[23][24][25][26][27].<\/strong><\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-744b2ba0 elementor-widget elementor-widget-text-editor\" data-id=\"744b2ba0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>CTO bie\u017e\u0101k sastopami gados vec\u0101kiem pacientiem. P\u0113t\u012bjumi liecina, ka CTO izplat\u012bba ir 36,5% pacientiem l\u012bdz 65 gadu vecumam, 39,1% vecum\u0101 no 65 l\u012bdz 79 gadiem un 40,7% pacientiem, kas vec\u0101ki par 80 gadiem <strong>[16].<\/strong> Lab\u0101 koron\u0101r\u0101 art\u0113rija ir visbie\u017e\u0101k skartais ku\u0123is, kam seko kreis\u0101s priek\u0161\u0113j\u0101s lejupejo\u0161\u0101s un kreis\u0101s cirkuma art\u0113rijas. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-315cc02d elementor-widget elementor-widget-image\" data-id=\"315cc02d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"486\" height=\"484\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g001-1.jpg\" class=\"attachment-large size-large wp-image-10589\" alt=\"\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g001-1.jpg 486w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g001-1-300x300.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g001-1-150x150.jpg 150w\" sizes=\"(max-width: 486px) 100vw, 486px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">CTO PCI indik\u0101cijas [29]<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-410ed0b5 elementor-widget elementor-widget-text-editor\" data-id=\"410ed0b5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Nodro\u0161in\u0101juma aprites kl\u0101tb\u016btne nenov\u0113r\u0161 i\u0161\u0113miju nosl\u0113gtaj\u0101 teritorij\u0101. T\u0101p\u0113c nodro\u0161in\u0101juma cirkul\u0101cijas lielumam nevajadz\u0113tu b\u016bt kontrindik\u0101cijai revaskulariz\u0101cijai <strong>[4].<\/strong> Iz\u0161\u0137iro\u0161a noz\u012bme ir i\u0161\u0113mijas un miokarda dz\u012bvotsp\u0113jas nov\u0113rt\u0113\u0161anai. <br>Asimptom\u0101tiskiem pacientiem i\u0161\u0113mijas nov\u0113rt\u0113\u0161ana ir ieteicama pirms CTO PCI. Proced\u016bras pan\u0101kumi ir atkar\u012bgi no t\u0101, vai sirds audi saglab\u0101 potenci\u0101lu atg\u016bties. Ieteicamas visaptvero\u0161as diagnostikas metodes, piem\u0113ram, transmur\u0101l\u0101 infarkta nov\u0113rt\u0113\u0161ana, kontraktil\u0101s rezerves nov\u0113rt\u0113\u0161ana ar dobutam\u012bnu un sirds MRI norm\u0101lai miokarda sienas sabiez\u0113\u0161anai, \u012bpa\u0161i noz\u012bm\u012bgu, bet nepla\u0161u infarktu gad\u012bjumos <strong>[5].<\/strong>   <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2c681877 e-flex e-con-boxed e-con e-parent\" data-id=\"2c681877\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-6963113e e-con-full e-flex e-con e-child\" data-id=\"6963113e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5a56785b elementor-widget elementor-widget-heading\" data-id=\"5a56785b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Proced\u016bras pl\u0101no\u0161ana<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-44c7953 elementor-widget elementor-widget-text-editor\" data-id=\"44c7953\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Pirmsproced\u016bras pl\u0101no\u0161ana ietver angiogr\u0101fisko v\u0113rt\u0113\u0161anu, lai nov\u0113rt\u0113tu veiksmes varb\u016bt\u012bbu un noteiktu pieeju. J-CTO rezult\u0101ts ir viens no vispla\u0161\u0101k izmantotajiem r\u012bkiem. Hibr\u012bda algoritma izstr\u0101de ir v\u0113l vair\u0101k optimiz\u0113jusi pan\u0101kumu r\u0101d\u012bt\u0101jus, samazinot proced\u016bras laiku, starojuma iedarb\u012bbu un kontrasta izmanto\u0161anu, vienlaikus standartiz\u0113jot metodes un samazinot main\u012bgumu operatoru vid\u016b. \u0160is algoritms \u013cauj sistem\u0101tiski p\u0101riet starp strat\u0113\u0123ij\u0101m, maksim\u0101li palielinot pan\u0101kumus un samazinot risku <strong>[11][12] <\/strong><br>Liela apjoma centri Zieme\u013camerik\u0101 un Eirop\u0101 ir zi\u0146oju\u0161i par pan\u0101kumu r\u0101d\u012bt\u0101jiem, kas p\u0101rsniedz 90%, ievie\u0161ot standartiz\u0113tu hibr\u012bda algoritmu. \u0160\u012b metode ietver divu vado\u0161o katetru ievieto\u0161anu &#8211; vienu katr\u0101 koron\u0101raj\u0101 art\u0113rij\u0101 (vai apvedce\u013ca transplant\u0101t\u0101) &#8211; lai atvieglotu dubult\u0101s injekcijas un \u013cautu nevainojami p\u0101rsl\u0113gties starp antegr\u0101d\u0101m un retrogr\u0101d\u0101m elektroinstal\u0101cijas pieej\u0101m. Divk\u0101r\u0161\u0101s injekcijas angiogramma nov\u0113rt\u0113 boj\u0101jumu \u012bpa\u0161\u012bbas, ieskaitot garumu un s\u0101nu art\u0113riju anatomiju. Pamatojoties uz \u0161iem konstat\u0113jumiem, operatori nosaka optim\u0101lo elektroinstal\u0101cijas pieeju un uzrauga procesu\u0101los parametrus, piem\u0113ram, laiku, starojuma iedarb\u012bbu un kontrasta apjomu. \u0160is algoritms ir izr\u0101d\u012bjies veiksm\u012bgs pat augsta riska pacientiem ar iepriek\u0161\u0113ju CABG, sasniedzot 87,5% procesu\u0101lo pan\u0101kumu r\u0101d\u012bt\u0101ju <strong>[11].<\/strong>       <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-42926a91 elementor-widget elementor-widget-image\" data-id=\"42926a91\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1056\" height=\"710\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g002.jpg\" class=\"attachment-full size-full wp-image-10594\" alt=\"\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g002.jpg 1056w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g002-300x202.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g002-1024x688.jpg 1024w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/fcvm-11-1350549-g002-768x516.jpg 768w\" sizes=\"(max-width: 1056px) 100vw, 1056px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">CTO PCI programmas ieteikumi [29]<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2424d362 e-flex e-con-boxed e-con e-parent\" data-id=\"2424d362\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-142568be e-flex e-con-boxed e-con e-child\" data-id=\"142568be\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4e0d34a0 e-con-full e-flex e-con e-child\" data-id=\"4e0d34a0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-241f4080 elementor-widget elementor-widget-heading\" data-id=\"241f4080\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CTO proced\u016bras so\u013ci<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38212067 elementor-widget elementor-widget-text-editor\" data-id=\"38212067\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Proced\u016bra ir l\u012bdz\u012bga sirds kateteriz\u0101cijai. Lai noteiktu skaidru kl\u012bnisko indik\u0101ciju, pacientiem j\u0101veic r\u016bp\u012bgs pirmsproced\u016bras nov\u0113rt\u0113jums, kas ietver simptomu, i\u0161\u0113mijas un dz\u012bvotsp\u0113jas testus <strong>[9]Proced\u016bras<\/strong> galvenie so\u013ci ietver: <\/p><ol><li><strong>Vado\u0161\u0101 katetra ievieto\u0161ana<\/strong> \u2013 \u013cauj piek\u013c\u016bt CTO boj\u0101jumam.<\/li><li><strong>Vadvadu \u0161\u0137\u0113rso\u0161ana<\/strong> \u2013 tiek izmantoti specializ\u0113ti CTO vadi un mikrokatetri.<\/li><li><strong>Sadal\u012b\u0161anas\/atgrie\u0161an\u0101s pa\u0146\u0113mieni<\/strong> \u2013 sare\u017e\u0123\u012btos gad\u012bjumos var izmantot retrogr\u0101du pieeju caur s\u0101nu art\u0113rij\u0101m.<\/li><li><strong>Balona angioplastika<\/strong> \u2013 kad vadvads ir veiksm\u012bgi virz\u012bts, art\u0113rija tiek papla\u0161in\u0101ta.<\/li><li><strong>Stent\u0113\u0161ana<\/strong> \u2013 saglab\u0101t caurlaid\u012bbu un samazin\u0101t restenozes risku.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-75f1e801 elementor-widget elementor-widget-heading\" data-id=\"75f1e801\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CTO PCI metodes un pieejas<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a3bd9a7 elementor-widget elementor-widget-text-editor\" data-id=\"a3bd9a7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>CTO PCI prasa padzi\u013cin\u0101tas prasmes un specializ\u0113tu apr\u012bkojumu. Galven\u0101s metodes ietver: <\/p><ul><li><strong>Antegr\u0101da stiep\u013cu eskal\u0101cija (AWE):<\/strong> Izmanto pak\u0101peniski stingr\u0101kus vadotnes, lai iek\u013c\u016btu okl\u016bzij\u0101.<\/li><li><strong>Antegr\u0101da sadal\u012b\u0161ana un atk\u0101rtota iece\u013co\u0161ana (ADR):<\/strong> Izmanto kontrol\u0113tu subintimu disekciju boj\u0101jumu \u0161\u0137\u0113rso\u0161anai.<\/li><li><strong>Retrogr\u0101da pieeja:<\/strong> Piek\u013c\u016bst CTO boj\u0101jumam caur s\u0101nu art\u0113rij\u0101m, ko bie\u017ei izmanto, ja antegr\u0101das m\u0113\u0123in\u0101jumi neizdodas.<\/li><li><strong>Hibr\u012bda pieeja:<\/strong> Integr\u0113 vair\u0101kas strat\u0113\u0123ijas optim\u0101liem pan\u0101kumiem. Jaun\u0101kie p\u0113t\u012bjumi zi\u0146o par 85\u201390% pan\u0101kumu l\u012bmeni, izmantojot \u0161o pieeju <strong>[6][7][8],<\/strong> un ASV b\u0101z\u0113tie CTO centri zi\u0146o par tehnisko pan\u0101kumu l\u012bmeni, kas p\u0101rsniedz 90%. Iev\u0113rojot stingru hibr\u012bda pieeju, pan\u0101kumu r\u0101d\u012bt\u0101ji sasniedz 93,4% pacientiem bez iepriek\u0161\u0113jas CABG un 88,1% tiem, kuriem bija iepriek\u0161\u0113js CABG <strong>[20].<\/strong>  <\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e22e02b elementor-widget elementor-widget-image\" data-id=\"2e22e02b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"844\" height=\"743\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/technikos.jpg\" class=\"attachment-full size-full wp-image-10598\" alt=\"\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/technikos.jpg 844w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/technikos-300x264.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/technikos-768x676.jpg 768w\" sizes=\"(max-width: 844px) 100vw, 844px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-594ba5c3 e-flex e-con-boxed e-con e-parent\" data-id=\"594ba5c3\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-55f8b37e e-con-full e-flex e-con e-child\" data-id=\"55f8b37e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1377570a elementor-widget elementor-widget-heading\" data-id=\"1377570a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CTO PCI priek\u0161roc\u012bbas<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-668a0ef4 elementor-widget elementor-widget-text-editor\" data-id=\"668a0ef4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>CTO PCI ir strauji att\u012bsto\u0161a joma. Izmantojot pareizo apr\u012bkojumu un pa\u0161reiz\u0113j\u0101s metodes, liela apjoma un ekspert\u012bzes centri sasniedz augstus pan\u0101kumu r\u0101d\u012bt\u0101jus. Veiksm\u012bga CTO rekanaliz\u0101cija ir saist\u012bta ar vair\u0101kiem kl\u012bniskiem ieguvumiem, piem\u0113ram, uzlabotu stenokardiju, dz\u012bves kvalit\u0101ti un fizisko ierobe\u017eojumu, uzlabotu kambaru funkciju un samazin\u0101tu mirst\u012bbu, sal\u012bdzinot ar pacientiem, kuru rekanaliz\u0101cija nebija veiksm\u012bga.  <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66febaf elementor-widget elementor-widget-image\" data-id=\"66febaf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"359\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/lentele.webp\" class=\"attachment-large size-large wp-image-10602\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-57e048c3 elementor-widget elementor-widget-image\" data-id=\"57e048c3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"217\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/studija-succes-rates-1024x278.jpg\" class=\"attachment-large size-large wp-image-10606\" alt=\"\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/studija-succes-rates-1024x278.jpg 1024w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/studija-succes-rates-300x81.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/studija-succes-rates-768x208.jpg 768w, https:\/\/ambercell.eu\/wp-content\/uploads\/2025\/04\/studija-succes-rates.jpg 1040w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">CTO KIP pan\u0101kumu r\u0101d\u012bt\u0101ji pa publik\u0101cij\u0101m [26]  <\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-319e3082 elementor-widget elementor-widget-text-editor\" data-id=\"319e3082\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>It\u0101lijas CTO re\u0123istrs nov\u0113rt\u0113ja kl\u012bniskos rezult\u0101tus 1 777 pacientiem, uzr\u0101dot zem\u0101ku sirds mirst\u012bbu (1,4, 4,7 un 6,3%, p &lt; 0,001) un MACE p\u0113c viena gada (2,6, 8,2 un 6,9%, &lt; p 0,001) pacientiem, kas \u0101rst\u0113ti ar PCI, sal\u012bdzinot ar kl\u012bnisko \u0101rst\u0113\u0161anu vai oper\u0101ciju. \u0160aj\u0101 p\u0113t\u012bjum\u0101 grupa, kas sa\u0146\u0113ma optimiz\u0113tu medic\u012bnisko \u0101rst\u0113\u0161anu, uzr\u0101d\u012bja augst\u0101ku MACE, n\u0101ves un atk\u0101rtotas hospitaliz\u0101cijas r\u0101d\u012bt\u0101jus<strong>[13]<\/strong> <\/li><li>Sapontis et al. nov\u0113rt\u0113ja dz\u012bves kvalit\u0101ti 1,000 pacientiem, kas pak\u013cauti OCT PCI. Viena m\u0113ne\u0161a nov\u0113ro\u0161ana par\u0101d\u012bja iev\u0113rojamu uzlabojumu vis\u0101s Sietlas stenokardijas anketas (SAQ), ro\u017eu elpas skalas un PHQ-8 punktu <strong>jom\u0101s [14]<\/strong> <\/li><li>Jap\u0101n\u0101 904 sec\u012bg\u0101s proced\u016br\u0101s, kas saist\u012btas ar PCI CTO laik\u0101 no 2002. l\u012bdz 2008. gadam (Rathore et al., 2009). Iespaid\u012bgi, ka tehniskie pan\u0101kumi tika sasniegti 87,5% boj\u0101jumu, ar procesu\u0101liem pan\u0101kumiem (defin\u0113ti k\u0101 tehniskie pan\u0101kumi bez MACE) 86,2% boj\u0101jumu. Katru gadu palielin\u0101j\u0101s da\u017e\u0101du vadstiep\u013cu \u0161\u0137\u0113rso\u0161anas pa\u0146\u0113mienu izmanto\u0161ana (paral\u0113ls vads, retrogr\u0101ds vads, intravaskul\u0101r\u0101 ultraska\u0146as vad\u012bba un CART). Slimn\u012bcas MACE r\u0101d\u012bt\u0101ji bija 1,5% grup\u0101 ar veiksm\u012bgu CTO PCI un nedaudz augst\u0101ki &#8211; 4,4% grup\u0101 ar neveiksm\u012bgu PCI (p = 0,027)<strong>[21]<\/strong>   <\/li><li>Nesen\u0101 metaanal\u012bz\u0113, kas ietver 9 p\u0113t\u012bjumus ar vair\u0101k nek\u0101 6,400 pacientiem, veiksm\u012bgas CTO rekanaliz\u0101cijas ilgtermi\u0146a kl\u012bniskie rezult\u0101ti tika sal\u012bdzin\u0101ti ar tiem, kuriem rekanaliz\u0101cija bija neveiksm\u012bga. \u0160aj\u0101 p\u0113t\u012bjum\u0101 n\u0101ves, AMI un MACE risks bija aptuveni par 50% zem\u0101ks pacientiem ar CTO rekanaliz\u0101ciju, un par 90% maz\u0101ka miokarda revaskulariz\u0101cija <strong>[15]<\/strong> <\/li><li><strong>EuroCTO daudzcentru p\u0113t\u012bjums (randomiz\u0113ts multicentru p\u0113t\u012bjums, lai nov\u0113rt\u0113tu revaskulariz\u0101cijas vai optim\u0101las medic\u012bnisk\u0101s terapijas izmanto\u0161anu hronisku kop\u0113jo koron\u0101ro okl\u016bziju \u0101rst\u0113\u0161anai) nejau\u0161i iedal\u012bja 396 pacientus CTO-PCI, sal\u012bdzinot ar optim\u0101lu medic\u012bnisko terapiju. P\u0113c 12 m\u0113ne\u0161iem, sal\u012bdzinot ar pacientiem, kas nejau\u0161i nodal\u012bti tikai medic\u012bniskajai terapijai, pacientiem, kas nejau\u0161i iedal\u012bti CTO-PCI, bija liel\u0101ka stenokardijas bie\u017euma uzlabo\u0161an\u0101s (apak\u0161skalas izmai\u0146u starp\u012bba, 5,23; 95% TI, 1,75\u20138,71; P=0,003) un dz\u012bves kvalit\u0101te (apak\u0161skalas izmai\u0146u starp\u012bba, 6,62; 95% TI, 1,78\u201311,46; P = 0,007), k\u0101 nov\u0113rt\u0113ts ar Sietlas stenokardijas <strong>anketu. [22]<\/strong> <span style=\"font-weight: 500;\">  Pacientiem ar veiksm\u012bgu CTO PCI tika konstat\u0113ts, ka p\u0113c revaskulariz\u0101cijas ir maz\u0101k fizisku ierobe\u017eojumu, maz\u0101k stenokardijas, lab\u0101kas mobilit\u0101tes un paaugstin\u0101tas fizisk\u0101s aktivit\u0101tes p\u0113c revaskulariz\u0101cijas, sal\u012bdzinot ar pacientiem, kas \u0101rst\u0113ti tikai ar OMT. Turkl\u0101t nov\u0113rotie periprocesu\u0101lie riski bija zemi, un 12 m\u0113ne\u0161u MACE r\u0101d\u012bt\u0101ji bija sal\u012bdzin\u0101mi ar OMT grupu <\/span><strong>. [28]  <\/strong><br><\/strong><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c4cf78 elementor-widget elementor-widget-heading\" data-id=\"1c4cf78\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CTO PCI pan\u0101kumu r\u0101d\u012bt\u0101ji un prognoze<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-527412f2 elementor-widget elementor-widget-text-editor\" data-id=\"527412f2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><p>CTO-PCI pan\u0101kumu r\u0101d\u012bt\u0101ji ir iev\u0113rojami uzlaboju\u0161ies, pateicoties vadot\u0146u, mikrokatetru un att\u0113lveido\u0161anas tehnolo\u0123iju att\u012bst\u012bbai. Pa\u0161laik specializ\u0113ti centri ar pieredz\u0113ju\u0161iem operatoriem sasniedz pan\u0101kumu r\u0101d\u012bt\u0101jus, kas p\u0101rsniedz 85\u201390%. Vair\u0101ki galvenie faktori veicina procesu\u0101lo pan\u0101kumu:  <\/p><ul><li><strong>Pacientu izv\u0113le:<\/strong> Labv\u0113l\u012bgas anatomiskas \u012bpa\u0161\u012bbas un labi att\u012bst\u012bta s\u0101nu cirkul\u0101cija uzlabo rezult\u0101tus.<\/li><li><strong>Operatora pieredze:<\/strong> Kvalific\u0113ti intervences speci\u0101listi, kas izmanto progres\u012bvas metodes, var efekt\u012bv\u0101k p\u0101rvald\u012bt sare\u017e\u0123\u012btus gad\u012bjumus.<\/li><li><strong>Uzlabots att\u0113lveido\u0161anas atbalsts:<\/strong> T\u0101das tehnolo\u0123ijas k\u0101 intravaskul\u0101r\u0101 ultraska\u0146a (IVUS) un optisk\u0101 koherences tomogr\u0101fija (OCT) pal\u012bdz optimiz\u0113t stenta izvietojumu un nodro\u0161in\u0101t prec\u012bzu stieples pozicion\u0113\u0161anu.<\/li><\/ul><p>Ilgtermi\u0146a prognoze p\u0113c veiksm\u012bgas CTO-PCI ir labv\u0113l\u012bga, iev\u0113rojami samazinot stenokardijas simptomus un uzlabojot kreis\u0101 kambara funkciju atbilsto\u0161i atlas\u012btiem pacientiem.<\/p><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-206af6ae elementor-widget elementor-widget-heading\" data-id=\"206af6ae\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Secin\u0101jums<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5fa49984 elementor-widget elementor-widget-text-editor\" data-id=\"5fa49984\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>CTO-PCI loma m\u016bsdienu intervences kardiolo\u0123ij\u0101 strauji papla\u0161in\u0101s, p\u0101rveidojot sare\u017e\u0123\u012btas koron\u0101ro art\u0113riju slim\u012bbas \u0101rst\u0113\u0161anas strat\u0113\u0123ijas. Neskatoties uz v\u0113sturiski zemo izmanto\u0161anu, kas veido tikai aptuveni 5% no PCI proced\u016br\u0101m vis\u0101 pasaul\u0113<strong> [10] <\/strong>un m\u0113\u0123in\u0101ja tikai 10\u201315% gad\u012bjumu<strong> [16][17][18], <\/strong>tehnolo\u0123iju un operatoru zin\u0101\u0161anu att\u012bst\u012bba veicina paradigmas mai\u0146u. Pan\u0101kumu r\u0101d\u012bt\u0101ji ir iev\u0113rojami uzlaboju\u0161ies, bet komplik\u0101ciju r\u0101d\u012bt\u0101ji ir strauji samazin\u0101ju\u0161ies, k\u0101 to par\u0101d\u012bja Patel et al., kuri zi\u0146oja par galveno komplik\u0101ciju samazin\u0101\u0161anos no 1,6% (2000\u20132002) l\u012bdz tikai 0,5% (2009\u20132011 <strong>) [19].<\/strong>  <\/p><p>Randomiz\u0113ti kl\u012bniskie p\u0113t\u012bjumi atk\u0101rtoti apstiprina CTO-PCI galveno ieguvumu: izcilu simptomu atvieglo\u0161anu. Turkl\u0101t nep\u0101rtraukta inov\u0101cija p\u0101rv\u0113r\u0161 iepriek\u0161 &#8220;ne\u0101rst\u0113jamus&#8221; boj\u0101jumus dz\u012bvotsp\u0113j\u012bgos revaskulariz\u0101cijas m\u0113r\u0137os<strong> [29]. <\/strong>Sal\u012bdzinot ar optim\u0101lo medic\u012bnisko terapiju (OMT) vien, CTO-PCI nodro\u0161ina b\u016btiskus uzlabojumus pacientu vesel\u012bb\u0101, tostarp maz\u0101k fizisku ierobe\u017eojumu, samazin\u0101tu stenokardiju, uzlabotu mobilit\u0101ti un liel\u0101ku fizisko aktivit\u0101ti. <\/p><p>Ar past\u0101v\u012bgiem sasniegumiem att\u0113lveido\u0161an\u0101, vadvadu tehnolo\u0123ij\u0101s un procesu\u0101laj\u0101s metod\u0113s, CTO-PCI tuv\u0101kajos gados g\u016bs v\u0113l liel\u0101kus pan\u0101kumus. \u0100rstiem, kas p\u0101rvalda CTO pacientus, joproj\u0101m ir b\u016btiska piel\u0101gota, uz pacientu orient\u0113ta pieeja &#8211; izmantojot jaun\u0101k\u0101s metodes un pier\u0101d\u012bjumus, lai optimiz\u0113tu rezult\u0101tus un dz\u012bves kvalit\u0101ti. <\/p><p>Ar past\u0101v\u012bgiem sasniegumiem att\u0113lveido\u0161an\u0101, vadvadu tehnolo\u0123ij\u0101s un procesu\u0101laj\u0101s metod\u0113s, CTO-PCI tuv\u0101kajos gados g\u016bs v\u0113l liel\u0101kus pan\u0101kumus. \u0100rstiem, kas p\u0101rvalda CTO pacientus, joproj\u0101m ir b\u016btiska piel\u0101gota, uz pacientu orient\u0113ta pieeja &#8211; izmantojot jaun\u0101k\u0101s metodes un pier\u0101d\u012bjumus, lai optimiz\u0113tu rezult\u0101tus un dz\u012bves kvalit\u0101ti. <\/p><p> <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-443efea3 e-flex e-con-boxed e-con e-parent\" data-id=\"443efea3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7d7821bc elementor-widget__width-auto elementor-widget elementor-widget-text-editor\" data-id=\"7d7821bc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em>Avotiem:  <\/em><\/p><p><em><strong>[0]<\/strong> Christian O. Koelbl, Zoran S. Nedeljkovic2 un Alise K. Jacobs, Koron\u0101r\u0101 hroniska kop\u0113j\u0101 okl\u016bzija (CTO): p\u0101rskats; Kolumbijas Universit\u0101tes Kardiolo\u0123ijas noda\u013ca Sinaja kalna sirds instit\u016bts 4300 Alton Road De Hirsch Meyer Tower Suite 2070 Maiami Beach, FL 33140, ASV<\/em><br><em><strong>[1]<\/strong> Jeroudi OM, Alomar ME, Michael TT, El Sabbagh A, Patel VG, Mogabgab O et al. Koron\u0101ro hronisko kop\u0113jo okl\u016bziju izplat\u012bba un p\u0101rvald\u012bba terci\u0101r\u0101 veter\u0101nu lietu slimn\u012bc\u0101. Kateters Cardiovasc Interv. 2014; 84(4):637-43.   <\/em><br><em><strong>[2]<\/strong> Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V u.c.; Autori\/darba grupas locek\u013ci. 2014. gada ESC\/EACTS vadl\u012bnijas par miokarda revaskulariz\u0101ciju: Eiropas Kardiolo\u0123ijas biedr\u012bbas (ESC) un Eiropas Kardio-torak\u0101l\u0101s \u0137irur\u0123ijas asoci\u0101cijas (EACTS) miokarda revaskulariz\u0101cijas darba grupa. Eur, Sirds, J., 2014; 35(37):2541-619.  <\/em><br><em><strong>[3]<\/strong> Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ et al. ACC \/ AATS \/ AHA \/ ASE \/ ASNC \/ SCAI \/ SCCT \/ STS 2017 Piem\u0113roti lieto\u0161anas krit\u0113riji koron\u0101rajai revaskulariz\u0101cijai pacientiem ar stabilu i\u0161\u0113misku sirds slim\u012bbu: Amerikas Kardiolo\u0123ijas koled\u017eas atbilsto\u0161as lieto\u0161anas krit\u0113riju darba grupas, Amerikas kr\u016b\u0161u \u0137irur\u0123ijas asoci\u0101cijas, Amerikas Sirds asoci\u0101cijas zi\u0146ojums,  Amerikas ehokardiogr\u0101fijas biedr\u012bba, Amerikas Kodolkardiolo\u0123ijas biedr\u012bba, Sirds un asinsvadu angiogr\u0101fijas un iejauk\u0161an\u0101s biedr\u012bba, Sirds un asinsvadu datortomogr\u0101fijas biedr\u012bba un Kr\u016b\u0161u kurvja \u0137irurgu biedr\u012bba. J esmu pazaud\u0113jis Cardiol. 2017; 69(17):2212-41.   <\/em><br><em><strong>[4]<\/strong> Verners GS, Surber R, Ferrari M, Fritzenwanger M, Figulla HR. Nodro\u0161in\u0101jumu funkcion\u0101l\u0101 rezerve, kas nodro\u0161ina ilgsto\u0161u hronisku kop\u0113jo koron\u0101ro okl\u016bziju pacientiem bez iepriek\u0161\u0113ja miokarda infarkta. Eur, Sirds, J., 2006; 27(20):2406-12.  <\/em><br><em><strong>[5]<\/strong> &#8211; Kirschbaum SW, Rossi A, Boersma E, Springeling T, van de Ent M, Krestin GP et al. Apvienojot magn\u0113tisk\u0101s rezonanses dz\u012bvotsp\u0113jas main\u012bgos lielumus, lab\u0101k prognoz\u0113 miokarda funkcijas uzlabo\u0161anos pirms perkut\u0101nas koron\u0101r\u0101s iejauk\u0161an\u0101s. J\u016bs esat J Cardiol. 2012; 159(3):192-7.   <\/em><br><em><strong>[6]<\/strong> Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, et al. Hibr\u012bda pieeja uzlabo hroniskas piln\u012bgas okl\u016bzijas angioplastikas pan\u0101kumus. Sirds. 2016; 102(18):1486-93.   <\/em><br><em><strong>[7]<\/strong> Sapontis J, Solsberija AC, Yeh RW, Koens DJ, Hirai T, Lombardi W u.c. Agr\u012bni procesu\u0101lie un vesel\u012bbas st\u0101vok\u013ca rezult\u0101ti p\u0113c hroniskas piln\u012bgas okl\u016bzijas angioplastikas: zi\u0146ojums no OPEN-CTO re\u0123istra (rezult\u0101ti, pacienta vesel\u012bbas st\u0101voklis un efektivit\u0101te hronisk\u0101s piln\u012bg\u0101s okl\u016bzijas hibr\u012bdproced\u016br\u0101s). JACC Cardiovasc Interv. 2017; 10(15):1523-34.   <\/em><br><em><strong>[8]<\/strong> Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman RM et al. Hibr\u012bda pieejas pielietojums un rezult\u0101ti hroniskai piln\u012bgai okl\u016bzijai, perkut\u0101nai koron\u0101rajai iejauk\u0161an\u0101s m\u016bsdien\u012bg\u0101 daudzcentru ASV re\u0123istr\u0101. J\u016bs esat J Cardiol. 2015; 198:222-8   <\/em><\/p><p><em><strong>[9]<\/strong>Nombela-Franco L, Urena M, Jerez-Valero M, et al. J-hroniskas kop\u0113j\u0101s okl\u016bzijas r\u0101d\u012bt\u0101ja valid\u0101cija hroniskas kop\u0113j\u0101s okl\u016bzijas perkut\u0101nas koron\u0101r\u0101s iejauk\u0161an\u0101s gad\u012bjum\u0101 neatkar\u012bg\u0101 m\u016bsdienu kohort\u0101. Circ Cardiovasc Interv 2013; 6(6):635\u2013643  <\/em><br><em><strong>[10]<\/strong> &#8211; Guan C, Yang W, Song L et al. Ak\u016btu procesu\u0101lo rezult\u0101tu saist\u012b\u0161ana ar ilgtermi\u0146a rezult\u0101tiem p\u0113c CTO PCI. JACC Cardiovasc Interv 2021; 14(3):278\u201388.  <\/em><br><em><strong>[11]<\/strong> Christakopoulos GE, Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA u.c. Pacientu p\u0101rm\u0113r\u012bgas starojuma iedarb\u012bbas prognoz\u0113t\u0101ji hroniskas piln\u012bgas okl\u016bzijas koron\u0101r\u0101s iejauk\u0161an\u0101s laik\u0101: ieskats no m\u016bsdienu daudzcentru re\u0123istra. Vai J Cardiol. 2017; 33(4):478-84.   <\/em><br><em><strong>[12]<\/strong> Alter S, Brinkman M, Kalra S, Nazif T, Parikh M, Kirtane AJ et al. Jauna starojuma devas samazin\u0101\u0161anas fluoroskopisk\u0101 tehnolo\u0123ija atvieglo hronisku piln\u012bgu okl\u016bziju, perkut\u0101nu koron\u0101ro iejauk\u0161anos. EuroIntervention. 2017; 13 (12): e1468-e1474.   <\/em><\/p><p><em><strong>[13]<\/strong> Tomasello SD, Boukhris M, Jubilato S, Marza F, Garbo R, Contegiacomo G, et al. \u0100rst\u0113\u0161anas strat\u0113\u0123ijas pacientiem, kurus sk\u0101rusi hroniska kop\u0113j\u0101 okl\u016bzija: rezult\u0101ti no It\u0101lijas hronisku kop\u0113jo okl\u016bziju re\u0123istra. Eur, Sirds, J. 2015; 36(45):3189-98.  <\/em><br><em><strong>[14]<\/strong> Sapontis J, Solsberija AC, Yeh RW, Koens DJ, Hirai T, Lombardi W u.c. Agr\u012bni procesu\u0101lie un vesel\u012bbas st\u0101vok\u013ca rezult\u0101ti p\u0113c hroniskas piln\u012bgas okl\u016bzijas angioplastikas: zi\u0146ojums no OPEN-CTO re\u0123istra (rezult\u0101ti, pacienta vesel\u012bbas st\u0101voklis un efektivit\u0101te hronisk\u0101s piln\u012bg\u0101s okl\u016bzijas hibr\u012bdproced\u016br\u0101s). JACC Cardiovasc Interv. 2017; 10(15):1523-34.   <\/em><br><em><strong>[15]<\/strong> Gao L, Wang Y, Liu Y, Cao F, Chen Y. Ilgtermi\u0146a kl\u012bniskie rezult\u0101ti veiksm\u012bgai revaskulariz\u0101cijai ar narkotiku elu\u0113jo\u0161iem stentiem hroniskiem kop\u0113jiem okl\u016bzij\u0101m: sistem\u0101tisks p\u0101rskats un metaanal\u012bze. Kateteriz\u0101cija un sirds un asinsvadu iejauk\u0161an\u0101s : Sirds angiogr\u0101fijas un iejauk\u0161an\u0101s biedr\u012bbas ofici\u0101lais \u017eurn\u0101ls. 2017; 89 (S1): 574-81.  <\/em><br><em><strong>[16]<\/strong> Koens HA, Viljamss DO, Holmss DR u.c. Vecuma ietekme uz procesu\u0101lo un 1 gada izn\u0101kumu perkut\u0101n\u0101 translumin\u0101laj\u0101 koron\u0101raj\u0101 angioplastik\u0101: NHLBI dinamisk\u0101 re\u0123istra zi\u0146ojums. Am Sirds J. 2003; 146(3):513-519<\/em><br><em><strong>[17]<\/strong> Fefer P, Knudtson ML, Cheema AN, et al. Pa\u0161reiz\u0113j\u0101s perspekt\u012bvas par koron\u0101ro hronisku kop\u0113jo okl\u016bziju: Kan\u0101das daudzcentru hronisko kop\u0113jo okl\u016bziju re\u0123istrs. J esmu pazaud\u0113jis Cardiol. 2012; 59(11):991-997.   <\/em><br><em><strong>[18]<\/strong> Grantham JA, Marso SP, Spertus J, et al. Hroniska piln\u012bga okl\u016bzijas angioplastika Amerikas Savienotaj\u0101s Valst\u012bs. JACC Cardiovasc Interv. 2009; 2(6):479-486.   <\/em><br><em><strong>[19]<\/strong> Patel VG, Brayton KM, Tamayo A, et al. Angiogr\u0101fiskie pan\u0101kumi un proced\u016bras komplik\u0101cijas pacientiem, kuriem tiek veikta perkut\u0101na koron\u0101r\u0101 hroniska piln\u012bga okl\u016bzija iejauk\u0161an\u0101s. Sv\u0113rt\u0101 metaanal\u012bze ar 18,061 pacientu no 65 p\u0113t\u012bjumiem. JACC Cardiovasc Interv. 2013; 6(2).    <\/em><br><em><strong>[20]<\/strong> Christopoulos G, Menon RV, Karmpaliotis D, et al. &#8220;Hibr\u012bda pieejas&#8221; piem\u0113ro\u0161ana hroniskiem kop\u0113jiem okl\u016bzij\u0101m pacientiem ar iepriek\u0161\u0113ju koron\u0101ro art\u0113riju apvedce\u013ca transplant\u0101ta oper\u0101ciju no m\u016bsdienu multicentru ASV re\u0123istra). Am J Cardiol. 2014;   <\/em><br><em><strong>[21]<\/strong> Rathore S, Matsuo H, Terashima M, et al. Procesu\u0101lie un slimn\u012bcas rezult\u0101ti p\u0113c perkut\u0101nas koron\u0101r\u0101s iejauk\u0161an\u0101s kron\u0101ro art\u0113riju hronisku kop\u0113jo okl\u016bziju gad\u012bjum\u0101 no 2002. l\u012bdz 2008. gadam. Jaunu vadvadu meto\u017eu ietekme. JACC Cardiovasc Interv. 2009; 2(6):489-497.    <\/em><br><em><strong>[22]<\/strong> Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J u.c.; EUROCTO izm\u0113\u0123in\u0101jumu p\u0113tnieki. Randomiz\u0113ts daudzcentru p\u0113t\u012bjums, lai sal\u012bdzin\u0101tu revaskulariz\u0101ciju ar optim\u0101lu medic\u012bnisko terapiju hronisku kop\u0113jo koron\u0101ro okl\u016bziju \u0101rst\u0113\u0161anai. Eur Sirds J. 2018; 39:2484\u20132493. doi:10.1093\/eurheartj\/ehy220   <\/em><br><em><strong>[23]<\/strong> Schumacher SP, Stuijfzand WJ, de Winter RW, van Diemen PA, Bom MJ, Everaars H, et al. I\u0161\u0113misk\u0101 slodzes samazin\u0101\u0161ana un ilgtermi\u0146a kl\u012bniskie rezult\u0101ti p\u0113c hroniskas piln\u012bgas okl\u016bzijas perkut\u0101nas koron\u0101r\u0101s iejauk\u0161an\u0101s. JACC Cardiovasc Interv. (2021) 14:1407\u201318. doi: 10.1016\/j.jcin.2021.04.044    <\/em><br><em>[24] Zhao S, Wang J, Chen Y, Wang W, Hu W, Zou Y u.c. Simptomu un dz\u012bves kvalit\u0101tes uzlabo\u0161ana p\u0113c veiksm\u012bgas perkut\u0101nas koron\u0101r\u0101s iejauk\u0161an\u0101s hroniskai piln\u012bgai okl\u016bzijai gados vec\u0101kiem pacientiem. J Am Sirds asoci\u0101cija (2023) 12: e029034. doi: 10.1161\/JAHA.123.029034    <\/em><br><em><strong> Kucukseymen S, Iannaccone M, Grantham JA, Sapontis J, Juricic S, Ciardetti N et al. Hronisku kop\u0113jo okl\u016bziju veiksm\u012bgas perkut\u0101nas revaskulariz\u0101cijas asoci\u0101cija ar dz\u012bves kvalit\u0101ti: sistem\u0101tisks p\u0101rskats un metaanal\u012bze. JAMA Netw Open. (2023) 6: e2324522. doi: 10.1001\/jamanetworkopen.2023.24522<\/strong>    <\/em><br><em>[26] Megaly M, Brilakis ES, Abdelsalam M, Pershad A, Saad M, Garcia S u.c. Hroniskas piln\u012bgas okl\u016bzijas revaskulariz\u0101cijas ietekme uz kreis\u0101 kambara funkciju, ko nov\u0113rt\u0113 sirds magn\u0113tisk\u0101 rezonanse. JACC kardiovask\u0101 att\u0113lveido\u0161ana. (2021) 14:1076\u20138. doi:10.1016\/j.jcmg.2020.10.012    <\/em><br><em><strong>[27]<\/strong> Galassi AR, Brilakis ES, Boukhris M, Tomasello SD, Sianos G, Karmpaliotis D, et al. Koron\u0101ro hronisko kop\u0113jo okl\u016bziju perkut\u0101nas revaskulariz\u0101cijas piem\u0113rot\u012bba: p\u0101rskats. Sirds J. (2015) 37: 2692\u2013700. doi: 10.1093\/eurheartj\/ehv391   <\/em><br><em><strong>[28]<\/strong> Watanabe H, Morimoto T, Shiomi H, Furukawa Y, Nakagawa Y, Ando K et al. Hroniska kop\u0113j\u0101 okl\u016bzija art\u0113rij\u0101, kas nav saist\u012bta ar infarktu, ir cie\u0161i saist\u012bta ar paaugstin\u0101tu piecu gadu mirst\u012bbu pacientiem ar ak\u016btu miokarda infarktu ar ST segmenta paaugstin\u0101\u0161anos, kuriem tiek veikta prim\u0101r\u0101 perkut\u0101na koron\u0101r\u0101 iejauk\u0161an\u0101s (no CREDO-Kyoto AMI re\u0123istra). EuroIntervention. (2017) 12: e1874\u201382. doi: 10.4244\/EIJ-D-15-00421    <\/em><br><em><strong>[29]<\/strong> Lindsey Cilia, Michael Megaly, Michael Megaly, Rhian Davies Rhian, Davies Behnam N. Teherani Behnam N. Tehrani,. Truesdells, Aleksandrs G. Truesdels; Neiejauk\u0161an\u0101s kardiologa rokasgr\u0101mata koron\u0101raj\u0101m hronisk\u0101m kop\u0113j\u0101m okl\u016bzij\u0101m; Vird\u017e\u012bnijas sirds, Falls bazn\u012bca, VA, Amerikas Savienot\u0101s Valstis <\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ede3ba e-flex e-con-boxed e-con e-parent\" data-id=\"ede3ba\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-6c405540 e-flex e-con-boxed e-con e-child\" data-id=\"6c405540\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-419f815b e-flex e-con-boxed e-con e-child\" data-id=\"419f815b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-64193d24 e-con-full e-flex e-con e-child\" data-id=\"64193d24\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-611c9e01 elementor-widget elementor-widget-heading\" data-id=\"611c9e01\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Produkti<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5184670b e-con-full elementor-hidden-mobile e-flex e-con e-child\" data-id=\"5184670b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1c19c23a e-flex e-con-boxed e-con e-child\" data-id=\"1c19c23a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-205d7802 e-flex e-con-boxed e-con e-child\" data-id=\"205d7802\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-5be4b371 e-flex e-con-boxed e-con e-child\" data-id=\"5be4b371\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-20f53a47 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"20f53a47\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/quiremspheres%E2%84%A2-microspheres\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/elementor\/thumbs\/9-1-qllqn8feypy0pkqspzwyr7037ymnhac5rr4ewqtidg.webp\" title=\"9\" alt=\"9\" loading=\"lazy\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/quiremspheres%E2%84%A2-microspheres\" target=\"_blank\">QUIREM SF\u0112RAS<\/a><\/h3><p class=\"elementor-image-box-description\">Holmium platforma TERUM organiz\u0101cijai ir pirm\u0101 SIRT: visaptvero\u0161a platforma neoper\u0113jamu aknu audz\u0113ju \u0101rst\u0113\u0161anai. Quiremspheres\u2122: vien\u012bg\u0101 SIRT terapeitisk\u0101 mikrosf\u0113ra, ko izmanto k\u0101 da\u013cu no piln\u012bb\u0101 integr\u0113tas platformas<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2eb42663 e-flex e-con-boxed e-con e-child\" data-id=\"2eb42663\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3bc59eed elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"3bc59eed\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/occlusafe%E2%84%A2-temporary-occlusion-balloon-microcatheter\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/elementor\/thumbs\/10-qllqn2sdtpqarwyzmxh7c8fbnneg73prqz7i131ves.webp\" title=\"10\" alt=\"10\" loading=\"lazy\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/occlusafe%E2%84%A2-temporary-occlusion-balloon-microcatheter\" target=\"_blank\">OCCLUSAFE<\/a><\/h3><p class=\"elementor-image-box-description\">Terumo ra\u017eot\u0101ja okluz\u012bvais balonu mikrokataters sniedz iesp\u0113ju p\u0101rdal\u012bt asins pl\u016bsmu un pan\u0101kt mikrocirkul\u0101ciju, kas palielina \u0101rstniecisko vielu uzkr\u0101\u0161anos m\u0113r\u0137a boj\u0101jum\u0101 un samazina nem\u0113r\u0137a emboliz\u0101ciju.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5aea2dcd e-flex e-con-boxed e-con e-child\" data-id=\"5aea2dcd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-631bfd82 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"631bfd82\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/progreat%E2%84%A2-micro-catheter-system\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/elementor\/thumbs\/Untitled-design-8-qllqmy36vjjv5v5tedg2hrm0oq1m4m742by2mp8u9w.webp\" title=\"Untitled design\" alt=\"Untitled design\" loading=\"lazy\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/progreat%E2%84%A2-micro-catheter-system\" target=\"_blank\">PROGREAT  <\/a><\/h3><p class=\"elementor-image-box-description\">TERUMO mikrokatetrs ar integr\u0113tu vadu terapeitiskai emboliz\u0101cijai un angiogr\u0101fijai perif\u0113rajos asinsvados. Lieto\u0161anas \u0113rtums, iztur\u012bba pret saliekumiem, dist\u0101l\u0101 elast\u012bba<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3ba550a5 e-flex e-con-boxed e-con e-child\" data-id=\"3ba550a5\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7e8bedf8 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"7e8bedf8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/angio-seal%E2%84%A2-vip-vascular-closure-device\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/elementor\/thumbs\/Untitled-design-1-6-qllqmubu47epvfba0btk7sk6b6k59ts6ptc4pleeys.webp\" title=\"Untitled design (1)\" alt=\"Untitled design (1)\" loading=\"lazy\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/www.terumo-europe.com\/en-emea\/products\/angio-seal%E2%84%A2-vip-vascular-closure-device\" target=\"_blank\">ANGIO SEAL VIP<\/a><\/h3><p class=\"elementor-image-box-description\">Angio-Seal\u2122 VIP krustenisko v\u0113nu sl\u0113g\u0161anas ier\u012bce sl\u0113g\u0161anai un laika l\u012bdz hemost\u0101zes sa\u012bsin\u0101\u0161anai kop\u0113j\u0101s aug\u0161stilba art\u0113rijas punkcijas viet\u0101 pacientiem, kuriem tiek veikta diagnostisk\u0101 angiogr\u0101fija vai intervences proced\u016bras.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12b388df elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"12b388df\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-37fd6c8c elementor-widget elementor-widget-button\" data-id=\"37fd6c8c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/ambercell.eu\/lv\/produkti\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-long-arrow-alt-right\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M313.941 216H12c-6.627 0-12 5.373-12 12v56c0 6.627 5.373 12 12 12h301.941v46.059c0 21.382 25.851 32.09 40.971 16.971l86.059-86.059c9.373-9.373 9.373-24.569 0-33.941l-86.059-86.059c-15.119-15.119-40.971-4.411-40.971 16.971V216z\"><\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Visi produkti<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-358f0589 e-flex e-con-boxed e-con e-parent\" data-id=\"358f0589\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-717f9cec e-flex e-con-boxed e-con e-parent\" data-id=\"717f9cec\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-55dcfde e-con-full e-flex e-con e-child\" data-id=\"55dcfde\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":4353,"parent":5299,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4415","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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