BoganaShanmugam Vimalraj, Psaltis Peter J, Wong Dennis T, Seneviratne Sujith, Cameron James, Meredith Ian T, Malaiapan Yuvaraj
Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia; School of Medicine, University of Adelaide and Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
Heart Lung Circ. 2016 Jul;25(7):676-82. doi: 10.1016/j.hlc.2015.12.101. Epub 2016 Feb 6.
Chronic total occlusions (CTOs) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them.
We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012, in a multi-operator single centre, which is one of the largest volume PCI centres in Australia.
Eighty-two patients (62.6±11.3 years, 85% males) who had CTO-PCIs were included. The most common site of CTO was the right coronary artery (44%), followed by the left circumflex (30%) and left anterior descending (26%) arteries. Using the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. All PCIs were performed by antegrade approach. Selected procedural characteristics included: re-attempt procedure 10%; multiple access sites 21%; more than one guidewire 77%; additional support modality 60%; drug-eluting stents 97%; stent number 1.6±0.8; total stent length 40.1±24.5mm; fluoroscopy time 33±17min; contrast volume 257.2±110.8mL. Overall CTO success rate was 60%. In-hospital adverse outcomes included 1.2% mortality, 9.8% peri-procedural myocardial infarction, 4.9% emergency bypass surgery, 3% cardiac tamponade and 4.9% contrast induced nephropathy.
We report modest success rates in a single Australian centre experience in a relatively conservative cohort of CTO-PCI prior to the initiation of a dedicated CTO revascularisation program.
慢性完全闭塞病变（CTO）因其治疗所需技术的复杂性，在经皮冠状动脉介入治疗（PCI）中代表着一类独特的病变。
我们回顾性分析了2010年1月至2012年12月间在澳大利亚最大的PCI中心之一的多术者单中心进行CTO-PCI的经验。
纳入了82例行CTO-PCI的患者（年龄62.6±11.3岁，85%为男性）。CTO最常见的部位是右冠状动脉（44%），其次是左旋支（30%）和左前降支（26%）。采用日本CTO评分系统，34%的病变被分类为简单，37%为中等，23%为困难，6%为非常困难。所有PCI均采用正向入路。选定的手术特征包括：再次尝试手术10%；多个穿刺部位21%；使用一根以上导丝77%；额外的辅助方式60%；药物洗脱支架97%；支架数量1.6±0.8；总支架长度40.1±24.5mm；透视时间33±17分钟；造影剂用量257.2±110.8mL。总体CTO成功率为60%。院内不良结局包括1.2%的死亡率、9.8%的围手术期心肌梗死、4.9%的急诊搭桥手术、3%的心脏压塞和4.9%的造影剂诱发肾病。
在启动专门的CTO血运重建计划之前，我们报告了澳大利亚单个中心在相对保守的CTO-PCI队列中的适度成功率。
