病例介绍结束后，李建平教授与Brugaletta教授就是否需要处理RCA的CTO进行了富有价值的 探讨。

李建平教授回顾该冠心病患者的病情：存在三支病变，罪犯血管LAD中段严重狭窄，LCX临界病 变，RCA发展成了CTO，发觉术者团队最终并未对患者RCA的CTO进行处理[1]，想知道Brugaletta 教授是计划择期开通RCA的CTO吗？还是考虑其他因素后并没有计划开通？

参考原文：（Thank you very much Prof. Brugaletta. So this RCA is as the CTO lesion, and circumflex as the moderate lesion, the LAD was okay, would you want to open the     CTO lesion? [Which one of the following is ture? ] You didn’t plan to [open the CTO lesion], or you wanted to try it [=opening the CTO lesion] later? ）

Brugaletta教授道出了在当时治疗时，前前后后的通盘考虑：手术一开始时，我们的计划是在处理完LAD的罪犯病变后，看看是否有新的迹象。处理完LAD后，患者的术中心电提示下壁心肌存在一定的活性，但仍不足以证明下壁心肌是否正常，于是便又等LCX（的评估和处理结果来补充信息）。冠脉造影显示RCA存在良好的侧支循环，仿佛RCA自身（给下游）供血一样。于是在当场手术时，也就没有计划开通RCA的CTO。若LCX有和RCA类似的侧支循环，LCX的FFR阳性可能是假阳性[1]。但我们的情况不是这样：LCX没有像RCA这样的侧支循环，从而LCX的FFR没有问题。

参考原文：Acutely we didn’t [plan to]. Our plan was to wait for the sign, after we treated the lesion which was clearly in LAD, so we say that this patient ‘s cardiography shows there was some viability on the inferior part of the heart. So we didn’t know if his

inferior part of the heart was normal or not. We decided whether to perform or not the   RCA for PCI. So we say it let’s have a wait for the circumflex. The collateral circulation to the RCA, was done almost collaterally the same as the coronary artery,  you  see  the  angio, so the collateral circulation was through the  same coronary artery. And that was the reason why we say, we didn’t have any kind of problems performing FFR in the circumflex. Because the circumflex doesn’t have any collateral circulation like the RCA. Because sometimes another artery is the collateral circulation to the CTO, so you could have some positive value of the FFR. But this was not the case

[1] 若存在临界病变的冠脉（A）存在对完全闭塞或有严重狭窄的另一条血管（B）侧支供血的情况，A的FFR数值会因“窃血”（coronary steal）而偏低；为得到更准确的A血管FFR数值，对应测量通常应在受供血管B解除闭塞或严重狭窄情况之后进行。