慢性完全性冠状动脉闭塞的再通——尽管逆行途径使用受限，但成功率较高。
Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach.
作者信息
Bijuklic Klaudija, Schwencke Carsten, Schofer Joachim
机构信息
Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
出版信息
Catheter Cardiovasc Interv. 2016 Apr;87(5):E183-91. doi: 10.1002/ccd.26168. Epub 2015 Oct 1.
AIM
The retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly being used as a first-line intervention despite a higher radiation exposure, contrast volume, and a higher major adverse cardiac event (MACE) rate compared with the antegrade approach. It was aimed to evaluate the overall success rate of CTO-PCI over time when the retrograde approach was restrictively used only after a failed antegrade attempt.
METHODS AND RESULTS
In a prospective single operator registry from January 2008 to December 2012 about 436 consecutive patients underwent a CTO-PCI. Mean age was 63.4 ± 10.3 years, and 86% were male. The overall success rate improved significantly over time [68% (first quartile) to 91% (fourth quartile), P < 0.001] due to a significant increase of the antegrade success rate. This could be achieved by a retrograde approach of less than 20% with no change over time. The overall in-hospital MACE rate was 0.69% with no difference between antegrade and retrograde procedures.
CONCLUSIONS
A high CTO-PCI success rate of above 90% could be achieved with a restrictive use of the retrograde technique.
目的
在慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）中，逆行介入方法尽管与顺行介入方法相比辐射暴露更多、造影剂用量更大且主要不良心脏事件（MACE）发生率更高，但越来越多地被用作一线干预措施。本研究旨在评估仅在顺行尝试失败后才限制性地使用逆行介入方法时，CTO-PCI随时间推移的总体成功率。
方法与结果
在一项2008年1月至2012年12月的前瞻性单操作者注册研究中，约436例连续患者接受了CTO-PCI。平均年龄为63.4±10.3岁，86%为男性。由于顺行成功率显著提高，总体成功率随时间显著改善[从68%（第一四分位数）提高到91%（第四四分位数），P<0.001]。这可以通过逆行介入方法占比低于20%且随时间无变化来实现。总体住院期间MACE发生率为0.69%，顺行和逆行手术之间无差异。
结论
限制性使用逆行技术可实现高于90%的高CTO-PCI成功率。
Zotero 插件