Fang Hsiu-Yu, Fang Chih-Yuan, Hussein Hisham, Hsueh Shu-Kai, Yang Cheng-Hsu, Chen Chien-Jen, Hsieh Yuan-Kai, Hang Chi-Ling, Yip Hon-Kan, Wu Chiung-Jen
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, R.O.C.
Int Heart J. 2010 May;51(3):147-52. doi: 10.1536/ihj.51.147.
The efficacy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has improved dramatically due to the development of new devices. Severe calcification of coronary lesions may be encountered even when the guidewire crosses the CTO, preventing the balloon from penetrating the lesion. A new "Tornus" penetration catheter has been developed for CTO recanalization. The purpose of this study was to evaluate the feasibility and safety of the Tornus catheter compared with traditional rotational atherectomy for CTO lesions. From August 2002 to July 2009, 77 patients with CTO of the coronary artery were selected to undergo PCI. Forty-one patients were treated with rotational atherectomy before the availability of the Tornus catheter when the smallest balloon failed to pass the CTO lesion. Later, 36 patients were treated with a Tornus catheter. Device and angiographic success rates as well as procedural complications were assessed. Device success was defined when the Tornus or Rota burr passed through the lesion. Major complications included death, Q-myocardial infarction, or emergency bypass surgery. Minor complications included perforation, cardiac tamponade, no reflow phenomenon, or long spiral dissection.The mean procedural time was significantly longer in the Tornus group (144 minutes versus 115 minutes, P = 0.01), while the device success rate was significantly lower (77% versus 95%, P = 0.024). Rotational atherectomy was subsequently performed in 3 of 8 Tornus failure cases. There were no between group differences in major complication rate (6% Tornus versus 5% rotational atherectomy). There was an insignificant trend for lower minor complication rates in the Tornus group (17% versus 20%).Use of the Tornus catheter was associated with significantly longer procedural duration and lower device success rates compared to rotational atherectomy. Major and minor complications were not different between the groups. Our findings suggest that Tornus catheter penetration is not superior to conventional rotational atherectomy for CTO recanalization.
由于新型器械的发展，经皮冠状动脉介入治疗（PCI）对慢性完全闭塞病变（CTO）的疗效有了显著提高。即便导丝穿过CTO病变，仍可能遇到严重钙化的冠状动脉病变，从而阻止球囊穿透病变。一种新型的“Tornus”穿透导管已被研发用于CTO再通。本研究的目的是评估Tornus导管与传统旋磨术治疗CTO病变相比的可行性和安全性。从2002年8月至2009年7月，77例冠状动脉CTO患者被选来接受PCI治疗。在Tornus导管可用之前，当最小的球囊无法通过CTO病变时，41例患者接受了旋磨术治疗。后来，36例患者接受了Tornus导管治疗。评估了器械成功率、血管造影成功率以及手术并发症。当Tornus或旋磨头穿过病变时定义为器械成功。主要并发症包括死亡、Q波心肌梗死或急诊搭桥手术。次要并发症包括穿孔、心脏压塞、无复流现象或长螺旋形夹层。Tornus组的平均手术时间显著更长（144分钟对115分钟，P = 0.01），而器械成功率显著更低（77%对95%，P = 0.024）。在8例Tornus失败病例中有3例随后进行了旋磨术。两组之间的主要并发症发生率无差异（Tornus组为6%，旋磨术组为5%）。Tornus组次要并发症发生率有降低的趋势，但不显著（17%对20%）。与旋磨术相比，使用Tornus导管与显著更长的手术持续时间和更低的器械成功率相关。两组之间的主要和次要并发症无差异。我们的研究结果表明，对于CTO再通，Tornus导管穿透并不优于传统的旋磨术。
