Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.
Chin Med J (Engl). 2013 Mar;126(6):1086-91.
The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach.
Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated.
Mean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P < 0.01). Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P < 0.01). There were 17 (20.2%) patients failure of recanalize the CTO lesions, among which 13 (15.5%) were due to the failure of retrograde wire crossing the collaterals.
The retrograde approach is an effective technique to recanalize CTO lesions, the septal collateral was preferable. When the epicardial collateral is selected, careful manipulation of devices and wires is essential due to the potential risk of perforation of collateral channels.
逆行技术通过侧支循环已被应用于经皮冠状动脉再通治疗慢性完全闭塞（CTO）病变。本研究旨在探讨经逆行途径治疗时侧支循环相关并发症及再通成功率。
纳入 2005 年 7 月至 2012 年 7 月期间采用逆行途径的 84 例患者。评估患者特征、手术结果和住院期间临床事件。
患者平均年龄（59.6±11.2）岁，91.7%为男性。靶 CTO 病变分布于左前降支 45 例（53.5%）、左回旋支 1 例（1.2%）、右冠状动脉 34 例（40.5%）和左主干 4 例（4.8%）。再通成功率为 79.8%。间隔支用于逆行介入的次数是心外膜侧支的三倍，68/84（81%）比 16/84（19%）。58 例（72.6%）患者成功通过侧支通道输送导丝。有成功逆行导丝通过侧支通道的患者再通成功率为 93.1%（54/58），而没有成功的患者再通成功率为 50%（13/26）（P＜0.01）。在 68 个间隔支中，有 49 个（72.1%）和 16 个心外膜支中的 9 个（56.3%）（P=NS）成功通过逆行导丝。在成功通过逆行导丝后，间隔支组和心外膜组的再通成功率无显著差异（91.8%比 100%，P＞0.05）。15 例患者采用 CART 或逆行 CART 技术，其中 14 例（93.3%）成功再通。3 例（18.8%）患者发生心外膜侧支作为首选时的侧支相关穿孔（与间隔支组（0）相比，P＜0.01）。17 例（20.2%）患者未能成功开通 CTO 病变，其中 13 例（15.5%）是由于逆行导丝通过侧支循环失败。
逆行技术是开通 CTO 病变的有效技术，间隔支是首选。当选择心外膜侧支时，由于侧支循环穿孔的潜在风险，需要小心操作器械和导丝。
