Maeremans Joren, Knaapen Paul, Stuijfzand Wynand J, Kayaert Peter, Pereira Bruno, Barbato Emanuele, Dens Jo
aFaculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium bDepartment of Cardiology, VU University Medical Center, Amsterdam, The Netherlands cDepartment of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium dDepartment of Cardiology, l'Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg City, Luxembourg eDepartment of Cardiology, Onze-Lieve-Vrouwe Ziekenhuis Aalst, Aalst, Belgium fDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
J Cardiovasc Med (Hagerstown). 2016 Sep;17(9):680-6. doi: 10.2459/JCM.0000000000000340.
Antegrade wire escalation (AWE) remains the method of choice for tackling chronic total occlusions (CTOs), especially for lesions with low J-CTO score. To increase the number of operators which treat CTOs and increase AWE success rates, there is a need for a clear, algorithmic approach. We report the results of a simple AWE algorithm with new guidewire technology in coronary CTOs.
Hundred consecutive CTO lesions selected for AWE as the primary strategy were included in five Benelux centers. The algorithm follows a step-wise increase in guidewire tip load. Lesions were categorized according to the J-CTO score. Primary endpoint was successful guidewire crossing.
No differences in baseline demographics were present between successful and unsuccessful procedures. Overall, in 75% of the lesions AWE resulted in successful crossing. AWE success rates in easy, intermediate, difficult and very difficult CTOs were 83, 86, 71 and 43%, respectively. 46% could be crossed using a soft guidewire only. An additional success of 34 and 60% could be reached with an intermediate and stiff guidewire, respectively. Adding additional techniques resulted in 88% overall success. Procedure and fluoroscopy times, radiation doses and use of contrast were within highly acceptable ranges (67 ± 39 min, 27 ± 19 min, 1.7 ± 1.3 Gy, 264 ± 123 ml).
The algorithm and new wire technologies led to high success rates. AWE as a standalone procedure is highly successful in J-CTO 0-1. Low- and intermediate-volume CTO operators should try to implement a systematic approach in their CTO procedures, especially for lesions with low J-CTO scores. Adding additional techniques further increases these success rates.
正向导丝升级（AWE）仍然是处理慢性完全闭塞病变（CTO）的首选方法，特别是对于J-CTO评分较低的病变。为了增加治疗CTO的术者数量并提高AWE成功率，需要一种清晰的、算法化的方法。我们报告了一种在冠状动脉CTO中使用新型导丝技术的简单AWE算法的结果。
五个比荷卢经济联盟中心纳入了连续100例选择AWE作为主要策略的CTO病变。该算法遵循导丝尖端负荷逐步增加的原则。病变根据J-CTO评分进行分类。主要终点是导丝成功通过病变。
成功和不成功的手术在基线人口统计学方面没有差异。总体而言，75%的病变AWE导致成功通过。简单、中等、困难和极困难CTO的AWE成功率分别为83%、86%、71%和43%。仅使用软导丝46%的病变可以通过。分别使用中等硬度和硬导丝可额外获得34%和60%的成功率。增加其他技术后总体成功率达到88%。手术时间、透视时间、辐射剂量和造影剂使用量均在高度可接受范围内（67±39分钟、27±19分钟、1.7±1.3 Gy、264±123 ml）。
该算法和新型导丝技术导致了高成功率。AWE作为一种独立的手术在J-CTO 0-1病变中非常成功。低容量和中等容量的CTO术者在其CTO手术中应尝试采用系统的方法，特别是对于J-CTO评分较低的病变。增加其他技术可进一步提高这些成功率。
