逆行技术开通慢性完全闭塞病变的效率、安全性和长期随访：国际导师指导下的初始（贝尔格莱德）经验。

Efficiency, safety, and long-term follow-up of retrograde approach for CTO recanalization: initial (Belgrade) experience with international proctorship.

机构信息

Clinic for Cardiology, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia.

出版信息

J Interv Cardiol. 2012 Dec;25(6):540-8. doi: 10.1111/j.1540-8183.2012.00754.x. Epub 2012 Aug 16.

DOI:10.1111/j.1540-8183.2012.00754.x

PMID:22897353

Abstract

BACKGROUND

Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO) of coronary arteries.

OBJECTIVES

The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up.

METHODS

The study was a single center retrospective registry which included a total of 40 patients, of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization.

RESULTS

Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients, retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients, and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients. The success rate of these strategies was: 87.0% (20/23 patients) for primary, 87.5% (7/8 patients) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients) for retrograde after previous failed antegrade attempt, respectively. Total in-hospital major adverse cardiac events (MACE) rate was 5.0% (2 non-Q-wave myocardial infarctions). The MACE free survival at median follow-up of 20 months was 89% (95% CI: 78-100%).

CONCLUSIONS

This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long-term survival rate.

摘要

背景

逆行方法提高了经皮复杂慢性完全闭塞（CTO）冠状动脉再通的成功率。

目的

本研究旨在描述我们逆行经皮冠状动脉介入治疗 CTO 计划的初步经验，重点关注其安全性和可行性，以及长期临床随访。

方法

这是一项单中心回顾性登记研究，共纳入 40 例患者，占 2008 年 1 月至 2011 年 10 月期间 590 例 CTO 患者（6.7%），这些患者接受了逆行 CTO 再通治疗。

结果

平均闭塞时间为 37.8±40.3 个月。整体再通率为 87.5%（35/40）。所有病例均采用间隔侧支血管进入闭塞部位（100%）。逆行导丝成功穿过侧支血管的比例为 40/40（90.0%），这些患者 CTO 再通的成功率为 97.2%。逆行方法作为主要策略应用于 23/40（57.5%）例患者，在顺行失败后立即采用逆行方法应用于 8/40（20.0%）例患者，在先前顺行失败后选择性采用逆行方法应用于 9/40（22.5%）例患者。这些策略的成功率分别为：主要策略为 87.0%（23 例患者中的 20 例），顺行失败后立即采用逆行方法为 87.5%（8 例患者中的 7 例），先前顺行失败后采用逆行方法为 88.9%（9 例患者中的 8 例）。住院期间主要不良心脏事件（MACE）总发生率为 5.0%（2 例非 Q 波心肌梗死）。中位随访 20 个月时，MACE 无事件生存率为 89%（95%CI：78-100%）。