Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.
Cardiol J. 2013;20(5):560-7. doi: 10.5603/CJ.a2013.0063. Epub 2013 Jun 25.
The efficacy of trans-radial approach (TRA) in chronic total occlusions (CTO) percutaneous coronary interventions (PCI) is not well established. Thus, we sought to review the feasibility and long-term results of TRA for CTO PCI performed by dedicated TRA operatorsof our center.
CTO PCI performed by dedicated radialists were considered. Primary end-points were "PCI success" (stent implantation with residual stenosis < 20% and TIMI 3) and "patient success" (PCI success in a first or second attempt). Vascular complications and major adverse cardiac events (MACE) were also assessed. Procedures were divided into: Period 1 - no systematic adoption of TRA nor systematic wire selection, and Period 2 - systematic TRA with stepwise wire selection. The starting guidewire was initially an intermediate wire (Period 2a), and, thereafter, a tapered soft polymeric guidewire (Period 2b).
Two operators performed 167 TRA PCI on CTO in 158 patients. PCI success rate was 74.3% and patient success rate was 78.5%. Drug-eluting stents were implanted in 95.1% of successful procedures. One (0.6%) patient had a (minor) vascular complication. After a mean follow-up of 580 days, 93.7% of patients were free from MACE. PCI success (57.1% in Period 1 vs. 76.5% in Period 2a vs. 80.5% in Period 2b, p = 0.029) and patient success (62.5% in Period 1 vs. 77.8% in Period 2a vs. 86.1% in Period 2b, p = 0.025) significantly improved during the study.
CTO PCI by TRA is safe and feasible. Its efficacy seems to be strongly dependenton operator experience with CTO techniques and may be influenced by the strategy of guidewire selection.
经桡动脉入路（TRA）在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中的疗效尚未得到充分证实。因此，我们旨在回顾我们中心专门的 TRA 操作者行 CTO PCI 的可行性和长期结果。
纳入由专门的桡动脉介入医师行 CTO PCI 的患者。主要终点为“PCI 成功”（支架植入后残余狭窄<20%且 TIMI 血流 3 级）和“患者成功”（首次或第二次尝试时 PCI 成功）。还评估了血管并发症和主要心脏不良事件（MACE）。将手术分为：时期 1-不系统采用 TRA 也不系统选择导丝，时期 2-系统采用 TRA 并逐步选择导丝。起始导丝最初是中间导丝（时期 2a），之后是锥形软聚合物导丝（时期 2b）。
两名术者在 158 例患者中行 167 例 CTO TRA PCI。PCI 成功率为 74.3%，患者成功率为 78.5%。95.1%的成功手术中植入了药物洗脱支架。1 例（0.6%）患者发生（轻微）血管并发症。平均随访 580 天后，93.7%的患者无 MACE。PCI 成功率（时期 1 为 57.1%，时期 2a 为 76.5%，时期 2b 为 80.5%，p=0.029）和患者成功率（时期 1 为 62.5%，时期 2a 为 77.8%，时期 2b 为 86.1%，p=0.025）在研究期间显著提高。
TRA 行 CTO PCI 安全可行。其疗效似乎强烈依赖于术者对 CTO 技术的经验，可能受导丝选择策略的影响。
