Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
JACC Cardiovasc Interv. 2010 Feb;3(2):143-51. doi: 10.1016/j.jcin.2009.10.029.
Our aim was to investigate in-hospital outcomes of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) using contemporary techniques.
Despite its increasing popularity and technical complexity, clinical outcomes of PCI for CTO using contemporary techniques have not been adequately evaluated.
The J-CTO registry (multicenter CTO registry in Japan) is a large scale, multicenter registry enrolling consecutive patients undergoing PCI for CTO from 12 Japanese centers. In-hospital clinical outcomes were evaluated in 498 patients with 528 CTO lesions.
Multiple wiring strategies were frequently attempted (parallel wiring 31% and retrograde approach 25%) with relatively long guidewire manipulation time (median 30 min). Utilizing these complex strategies, high procedural success rates (88.6% in the first attempt cases and 68.5% in the retry cases) were accomplished. In-hospital adverse event rates were strikingly low (cardiac death 0.2%, Q-wave myocardial infarction 0.2%, and stroke 0%). Potential disadvantages of these procedures, including a large amount of contrast volume (median 293 ml) and long fluoroscopic time (median 45 min), were not associated with serious clinical sequelae (contrast induced nephropathy 1.2% and radiation dermatitis 0%). Although coronary perforations were documented frequently by angiography (antegrade 7.2% and retrograde 13.6%), clinically significant perforation resulting in cardiac tamponade was rare (0.4%).
Most CTO lesions can be safely and successfully treated with PCI utilizing contemporary advanced techniques. Invasiveness and potential risks of these strategies, which have been the greatest concerns of CTO treatment, may be acceptable in the majority of cases considering the actual incidences of related adverse events and the procedural success rates.
本研究旨在探讨应用当代技术行经皮冠状动脉介入治疗（PCI）慢性完全闭塞（CTO）的院内转归。
尽管 PCI 治疗 CTO 的应用日益广泛且技术日趋复杂，但应用当代技术治疗 CTO 的临床转归尚未得到充分评估。
日本 J-CTO 注册研究（日本多中心 CTO 注册研究）是一项大型多中心注册研究，纳入了来自 12 个日本中心的连续行 PCI 治疗 CTO 的患者。在 498 例 528 处 CTO 病变患者中评估了院内临床转归。
频繁尝试了多种导丝策略（并行导丝技术 31%，逆行技术 25%），导丝操作时间相对较长（中位数 30 分钟）。利用这些复杂策略，首次尝试的成功率较高（88.6%），再次尝试的成功率也较高（68.5%）。院内不良事件发生率极低（心脏性死亡 0.2%，Q 波心肌梗死 0.2%，卒中 0%）。这些操作的潜在缺点，包括造影剂用量大（中位数 293ml）和透视时间长（中位数 45 分钟），与严重的临床后果无关（造影剂肾病 1.2%，放射性皮炎 0%）。虽然经造影证实顺向和逆行穿孔分别为 7.2%和 13.6%，但导致心脏压塞的临床显著穿孔罕见（0.4%）。
应用当代先进技术，大多数 CTO 病变可安全且成功地接受 PCI 治疗。考虑到相关不良事件的实际发生率和手术成功率，这些策略的侵袭性和潜在风险（一直是 CTO 治疗最关注的问题）在大多数情况下可能是可以接受的。
