Vo Minh N, McCabe James M, Lombardi William L, Ducas John, Ravandi Amir, Brilakis Emmanouil S
Section of Cardiology, St. Boniface Hosipital, University of Manitoba, Winnipeg, Canada.
J Invasive Cardiol. 2015 Mar;27(3):139-44.
The feasibility of adopting the "hybrid" approach by a single operator without prior experience in percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has not been described.
Consecutive patients who underwent CTO-PCI by a single operator using the "hybrid" approach between 2012 and 2013 formed the analytic cohort. No patient was declined on the basis of angiographic findings. Clinical and angiographic characteristics together with procedural and hospital outcomes are described.
During the study period, a total of 48 consecutive patients underwent PCI of 50 CTOs. Mean age was 63.4 ± 9.4 years and most patients (83%) were men. The right coronary artery (RCA) was the most commonly treated CTO vessel (54%) and mean J-CTO score was 2.3 ± 1.1. A primary retrograde approach was chosen for 33% of lesions and 40% required use of an epicardial collateral vessel. The primary strategy was effective in 65% of successful cases, 35% required one change in strategy, and 15% requiring two strategy changes. Procedural success rate was 92%. The median number of stents used was 3 (interquartile range [IQR], 2-4] and the total stent length was 73 mm [IQR, 38-96 mm). Mean contrast volume was 356.4 ± 148.3 mL and the mean air kerma radiation exposure was 3.5 ± 2.0 Gy. No patient experienced a major periprocedural complication.
The "hybrid" approach to CTO-PCI can be successfully adopted by a single operator with excellent early procedural success and low complication rates, despite a lack of prior CTO-PCI experience.
单一术者在无慢性完全闭塞病变（CTO）经皮冠状动脉介入治疗（PCI）经验的情况下采用“杂交”方法的可行性尚未见报道。
2012年至2013年间由单一术者采用“杂交”方法进行CTO-PCI的连续患者组成分析队列。没有患者因血管造影结果而被拒绝治疗。描述了临床和血管造影特征以及手术和住院结局。
在研究期间，共有48例连续患者接受了50处CTO的PCI治疗。平均年龄为63.4±9.4岁，大多数患者（83%）为男性。右冠状动脉（RCA）是最常接受治疗的CTO血管（54%），平均J-CTO评分为2.3±1.1。33%的病变选择了主要逆行方法，40%需要使用心外膜侧支血管。主要策略在65%的成功病例中有效，35%需要改变一次策略，15%需要改变两次策略。手术成功率为92%。使用支架的中位数为3个（四分位间距[IQR]，2-4个），总支架长度为73mm（IQR，38-96mm）。平均对比剂用量为356.4±148.3mL，平均空气比释动能辐射暴露为3.5±2.0Gy。没有患者发生主要围手术期并发症。
尽管缺乏先前的CTO-PCI经验，但单一术者可以成功采用“杂交”方法进行CTO-PCI，早期手术成功率高且并发症发生率低。
