Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, Japan.
Circ Cardiovasc Interv. 2009 Apr;2(2):124-32. doi: 10.1161/CIRCINTERVENTIONS.108.838862. Epub 2009 Feb 20.
Retrograde approach through collaterals has been introduced for percutaneous recanalization of chronic total occlusion (CTO) of the coronary arteries. We investigated the safety and efficacy of retrograde approaches used for percutaneous recanalization of CTO in a consecutive series of patients.
We studied 157 consecutive patients who underwent retrograde CTO recanalization between 2003 and 2008 at a single center. A total of 118 (75.2%) of these patients have had previously failed antegrade attempts. Septal, epicardial, and saphenous vein graft collaterals were used in 67.5%, 24.8%, and 7.6% of cases, respectively. Collateral channel was crossed by guide wire successfully in 115 (73.2%) cases, and the procedure was successful by retrograde approach in 103 (65.6%) cases. Collateral channels (CCs) were graded as follows: CC0, no continuous connection; CC1, continuous thread-like connection; and CC2, continuous, small sidebranch-like connection. CC1, collateral tortuosity < 90 degrees , and angle with recipient vessel < 90 degrees (P<0.0001) were significant predictors of success. Epicardial channel use (P=0.01), CC0, corkscrew channel (P<0.0001), angle with recipient vessel > 90 degrees (P=0.0007), and nonvisibility of connection with recipient vessel were found to be significant predictors of procedural failure. The CC dissection was observed in 6 patients, with 1 needing coil embolization and others who were managed conservatively. The major adverse cardiac events were low, with 1 coronary artery bypass graft, 1 Q-wave myocardial infarction, 5 non-Q-wave myocardial infarctions, and no deaths in this group of patients.
The retrograde approach in CTO percutaneous coronary intervention is effective in recanalizing CTO. The success rate by retrograde approach was 65.6%, and final success was 85% in this group with acceptable overall adverse events. We have identified predictors of failure related to collateral morphology.
逆行技术已被应用于经皮冠状动脉慢性完全闭塞（CTO）的开通。本研究旨在探讨连续系列患者经皮 CTO 开通中逆行技术的安全性和有效性。
2003 年至 2008 年，我们在单中心连续入选了 157 例接受逆行 CTO 开通的患者。其中 118 例（75.2%）患者此前已行正向介入治疗失败。67.5%、24.8%和 7.6%的患者分别使用了间隔支、心外膜侧支和大隐静脉桥侧支。115 例（73.2%）患者的侧支通道导丝成功通过，103 例（65.6%）患者经逆行技术开通。侧支通道分级为：0 级，无连续连接；1 级，连续线状连接；2 级，连续小侧支样连接。1 级、侧支迂曲<90°、与靶血管成角<90°（P<0.0001）是成功的显著预测因素。心外膜侧支的使用（P=0.01）、0 级、螺旋状通道（P<0.0001）、与靶血管成角>90°（P=0.0007）、与靶血管连接不显影是手术失败的显著预测因素。6 例患者发生侧支夹层，1 例患者行弹簧圈栓塞，其余患者予保守治疗。主要不良心脏事件发生率低，该组患者中 1 例接受了冠状动脉旁路移植术，1 例发生 Q 波心肌梗死，5 例发生非 Q 波心肌梗死，无死亡。
逆行技术在 CTO 经皮冠状动脉介入治疗中能有效开通 CTO。该组患者的逆行技术开通成功率为 65.6%，最终成功率为 85%，总体不良事件发生率可接受。我们已经确定了与侧支形态相关的失败预测因素。
