Karacsonyi Judit, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Patel Mitul, Bahadorani John, Doing Anthony, Ali Ziad A, Karatasakis Aris, Danek Barbara A, Rangan Bavana V, Alame Aya J, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
Catheter Cardiovasc Interv. 2017 Jul;90(1):12-20. doi: 10.1002/ccd.26780. Epub 2016 Sep 21.
Balloon uncrossable lesions can be challenging to treat, requiring specialized techniques and equipment.
We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of balloon uncrossable lesions in a multicenter chronic total occlusion (CTO) percutaneous coronary intervention (PCI) registry.
Between 2012 and 2016, 718 CTO PCIs (in which the occlusion was successfully crossed with a guidewire) were performed in 701 patients at 11 US centers. Mean age was 65.6 ± 10 years and 84% of the patients were men. Balloon uncrossable lesions represented 9% of all CTOs. Balloon uncrossable CTOs had more moderate/severe calcification (82% vs. 52%, P < 0.0001), moderate/severe tortuosity (61% vs. 35% P < 0.0001) and higher J-CTO score (2.95 ± 1.32 vs. 2.43 ± 1.23, P = 0.005) as compared with the remaining lesions. Technical and procedural success was significantly lower for balloon uncrossable lesions (90.5% vs. 98.3%, P < 0.0001 and 88.9% vs. 96.6% P = 0.004), respectively, but the incidence of major adverse events was similar (1.6% vs. 2.2%, P = 0.751). Balloon uncrossable lesions required longer procedure (208 [interquartile range: 135, 258] vs. 135 [94, 194] min, P < 0.0001) and fluoroscopy (77 [52, 100] vs. 45 min [27, 75], P < 0.0001) time. Techniques used to treat balloon uncrossable lesions included balloon-assisted microdissection (23%), excimer laser atherectomy (18%), and rotational atherectomy (16%). Excimer laser atherectomy and balloon-assisted microdissection were associated with the highest technical and procedural success rates.
Balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment. © 2016 Wiley Periodicals, Inc.
无法通过球囊扩张的病变治疗起来具有挑战性，需要专门的技术和设备。
我们在一个多中心慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）注册研究中，对无法通过球囊扩张的病变的患病率、临床和血管造影特征、治疗方法及手术结果进行了研究。
2012年至2016年期间，美国11个中心的701例患者接受了718例CTO PCI手术（其中闭塞病变成功通过导丝穿过）。患者平均年龄为65.6±10岁，84%为男性。无法通过球囊扩张的病变占所有CTO病变的9%。与其他病变相比，无法通过球囊扩张的CTO病变有更多的中度/重度钙化（82%对52%，P<0.0001）、中度/重度迂曲（61%对35%，P<0.0001）以及更高的J-CTO评分（2.95±1.32对2.43±1.23，P=0.005）。无法通过球囊扩张的病变的技术成功率和手术成功率显著较低（分别为90.5%对98.3%，P<0.0001；88.9%对96.6%，P=0.004），但主要不良事件的发生率相似（1.6%对2.2%，P=0.751）。无法通过球囊扩张的病变需要更长的手术时间（208[四分位间距：135，258]分钟对135[94，194]分钟，P<0.0001）和透视时间（77[52，100]分钟对45分钟[27，75]，P<0.0001）。用于治疗无法通过球囊扩张的病变的技术包括球囊辅助微分离术（23%）、准分子激光消蚀术（18%）和旋磨术（16%）。准分子激光消蚀术和球囊辅助微分离术的技术成功率和手术成功率最高。
无法通过球囊扩张的CTO病变很常见，技术失败率高，需要专门技术才能成功治疗。©2016威利期刊公司
