Saito Shigeru, Tanaka Shinji, Hiroe Yoshitaka, Miyashita Yusuke, Takahashi Saeko, Satake Shutaro, Tanaka Kazushi
Division of Cardiology and Catheterization Laboratories, Heart Center of ShonanKamakura General Hospital, Kamakura City, Japan.
Catheter Cardiovasc Interv. 2003 Jul;59(3):305-11. doi: 10.1002/ccd.10505.
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still technically challenging. The use of tapered-tip guidewires in these lesions may improve the success rate of PCI. In order to avoid the needless radiation exposure or contrast consumption, we have to determine a guideline for the termination of procedures in these lesions. We retrospectively analyzed the data of 182 patients between April 1997 and December 1999 (phase 1) and 80 patients between January and August 2001 (phase 2) who underwent angioplasty for CTO lesions >/= 3 months. There were no significant differences in clinical or lesion characteristics except the use of tapered-tip guidewires. Tapered-tip guidewires were used in 60% of patients in phase 2 period but no patients in phase 1 period. The overall success rate of PCI was improved from 67% in phase 1 to 81% in phase 2 (P = 0.019). In the phase 2 period, the success rate was higher in tapered-type occlusion (P = 0.002) and shorter length of occlusion (P = 0.004). Total procedure time was 46 +/- 17 min and total volume of contrast dye was 180 +/- 63 ml. The success rate was higher in patients treated by transradial coronary intervention (TRI) than transfemoral coronary intervention (89% vs. 64%; P = 0.008). The use of tapered-tip guidewires can improve the success rate of PCI in CTO lesions. The following guideline for the termination of the procedures is reasonable: time from arterial access to successful penetration of a guidewire through occlusion </= 30 min; total procedure time </= 90 min; and total dye volume </= 300 ml. TRI can achieve a high success rate even in CTO lesions provided that the case selection is adequate.
经皮冠状动脉介入治疗（PCI）用于慢性完全闭塞（CTO）病变在技术上仍然具有挑战性。在这些病变中使用锥形头导丝可能会提高PCI的成功率。为了避免不必要的辐射暴露或造影剂消耗，我们必须确定这些病变介入操作终止的指导原则。我们回顾性分析了1997年4月至1999年12月期间182例患者（第一阶段）以及2001年1月至8月期间80例患者（第二阶段）的数据，这些患者均接受了针对病程≥3个月的CTO病变的血管成形术。除了锥形头导丝的使用外，临床或病变特征方面无显著差异。第二阶段60%的患者使用了锥形头导丝，而第一阶段无患者使用。PCI的总体成功率从第一阶段的67%提高到了第二阶段的81%（P = 0.019）。在第二阶段，锥形闭塞类型的成功率更高（P = 0.002），闭塞长度较短的成功率也更高（P = 0.004）。总操作时间为46±17分钟，造影剂总量为180±63毫升。经桡动脉冠状动脉介入治疗（TRI）的患者成功率高于经股动脉冠状动脉介入治疗（89%对64%；P = 0.008）。使用锥形头导丝可提高CTO病变PCI的成功率。以下介入操作终止的指导原则是合理的：从动脉穿刺到导丝成功穿过闭塞病变的时间≤30分钟；总操作时间≤90分钟；造影剂总量≤300毫升。只要病例选择得当，TRI即使在CTO病变中也能取得较高的成功率。
