Laboratory of Interventional Cardiology and Department of Cardiology, IRCCS Humanitas, Milan, Italy.
Int J Cardiol. 2013 Sep 10;167(6):2653-6. doi: 10.1016/j.ijcard.2012.06.124. Epub 2012 Jul 16.
Although the inability to cross the chronic total occlusion (CTO) with a guidewire is the most common reason for failure, one of the most frustrating situations that may occur during a recanalization procedure is when a guidewire crosses successfully but it is impossible to advance any device over the wire through the occluded segment. We assessed the application of the Tornus catheter and/or rotational atherectomy to improve the success rate of percutaneous recanalization of CTO.
From October 2009 to May 2011, 55 consecutive patients with CTO resistant to recanalization by conventional techniques were treated by the following step-by-step approach: 1) Tornus catheter and 2) eventual high speed rotational atherectomy.
Twenty-four lesions were successfully crossed by the Tornus catheter (43.5%). Rotational atherectomy was used in 31 patients (one with Tornus success and 30 with Tornus failure). A final angiographic success was obtained in 50/55 patients (91%) whereas in 5 patients both bail-out strategies failed (9%). As compared to the 24 CTO successfully treated by the Tornus catheter (Tornus-success group), the 31 patients in the Tornus-failure group were treated more often with the 2.1F Tornus catheter and had more severely calcified lesions. By multivariable regression analysis the single independent predictor of Tornus failure was the presence of severely calcified lesions.
The Tornus catheter is a safe and effective device allowing us to overcome the inability to cross a CTO with a balloon catheter in approximately 45% of cases. In severely calcified CTO rotational atherectomy should be performed first.
尽管导丝无法穿过慢性完全闭塞（CTO）是失败的最常见原因，但在再通过程中最令人沮丧的情况之一是导丝成功穿过，但无法将任何设备通过闭塞段推进到导丝上。我们评估了 Tornus 导管和/或旋转削切术在提高 CTO 经皮再通成功率方面的应用。
从 2009 年 10 月至 2011 年 5 月，55 例 CTO 经常规技术再通失败的患者采用以下逐步方法治疗：1）Tornus 导管和 2）高速旋转削切术。
24 处病变被 Tornus 导管成功穿过（43.5%）。在 31 例患者中使用了旋转削切术（1 例 Tornus 成功和 30 例 Tornus 失败）。55 例患者中有 50 例（91%）获得了最终的血管造影成功，而在 5 例患者中两种挽救策略均失败（9%）。与 24 例经 Tornus 导管成功治疗的 CTO（Tornus-成功组）相比，Tornus 失败组的 31 例患者更常使用 2.1F 的 Tornus 导管，且病变钙化更严重。多变量回归分析表明，Tornus 失败的唯一独立预测因素是严重钙化病变的存在。
Tornus 导管是一种安全有效的装置，可使我们在大约 45%的病例中克服使用球囊导管无法穿过 CTO 的问题。在严重钙化的 CTO 中，应首先进行旋转削切术。
