Khand Aleem, Patel Bilal, Palmer Nicholas, Jones Julia, Andron Mohammed, Perry Raph, Mehrotra Sanjay, Mitsudo Kazuaki
Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom School of Ageing and Chronic Diseases, University of Liverpool, Liverpool, United Kingdom
Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Angiology. 2015 Nov;66(10):925-32. doi: 10.1177/0003319715573902. Epub 2015 Mar 10.
To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility.
We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an "antegrade" approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]).
Successful retrograde wiring of collateral channels in selected patients undertaken by "CTO dedicated" operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access.
对慢性完全闭塞病变（CTO）的逆行导丝技术进行系统评价和荟萃分析，重点关注其安全性和可行性。
我们检索了1990年至2013年12月期间PubMed、Ovid、EMBASE和Cochrane数据库中的出版物，插入了一些与CTO心脏侧支循环相关的术语。共有18个病例系列（n范围为17 - 462），总计2280次CTO血运重建尝试符合CTO侧支通道逆行导丝技术研究的标准。没有随机对照研究比较初次顺行与初次逆行方法。CTO血运重建手术成功率在67%至90.6%之间，其中很大一部分患者之前的“顺行”方法失败。73.2%（n = 1670）的病例使用间隔穿支侧支，21.7%（n = 495）的病例使用心外膜通道。虽然侧支/冠状动脉穿孔并不罕见（n = 90，5%），但严重急性并发症并不常见；在合并人群中，有18例心包填塞（0.8%）和3例死亡（0.1%）。当操作者选择间隔穿支导丝（79.3%）作为逆行进入CTO主体的途径时，与心外膜冠状动脉导丝（72.5%）相比，成功的可能性显著更高（相对风险1.11 [95%置信区间：1.02 -
