慢性完全闭塞病变的冠状动脉空间分布：来自美国一项大型注册研究的见解
Coronary artery spatial distribution of chronic total occlusions: Insights from a large US registry.
作者信息
Garcia Santiago, Alraies M Chadi, Karatasakis Aris, Yannopoulos Demetris, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Patel Mitul P, Bahadorani John, Karacsonyi Judit, Kalsaria Pratik, Danek Barbara, Banerjee Subhash, Brilakis Emmanouil S
机构信息
Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota.
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
Catheter Cardiovasc Interv. 2017 Jul;90(1):23-30. doi: 10.1002/ccd.26844. Epub 2016 Nov 10.
OBJECTIVE
To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI).
BACKGROUND
Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery.
METHODS
We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree.
RESULTS
A total of 1,369 lesions in 1,348 patients (mean age 66 ± 10 years, 85% male) were included. CTO PCI of proximal segments (n = 633, 46%) was more common than of mid (n = 557, 41%) and distal segments (n = 179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P < 0.01), have prior coronary artery bypass graft surgery (P = 0.03) and lower ejection fraction (P = 0.04). CTOs occurring in proximal segments had longer length (P <0.01), proximal cap ambiguity (P < 0.01), and moderate/severe calcification (P < 0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64%, 53%, 56%, P < 0.01) consistent with the higher use of retrograde approach (47%, 33%, 37%, P < 0.01) relative to antegrade wire escalation (67%, 82%, 82%, P < 0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P = 0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P < 0.01. However, procedural success (87%, 90%, 85%, P = 0.1), technical success (89%, 91%, 88%, P = 0.24), and complications rates (2.8%, 2.5%, 2.2%, P = 0.88) were not different.
CONCLUSIONS
The most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates. © 2016 Wiley Periodicals, Inc.
目的
评估冠状动脉内慢性完全闭塞（CTO）的空间分布，并描述CTO经皮冠状动脉介入治疗（PCI）的手术策略及结果。
背景
因斑块破裂导致的急性闭塞往往聚集在冠状动脉近端三分之一处。
方法
我们根据冠状动脉树内病变位置检查了1348例患者的临床和手术特征。
结果
共纳入1348例患者的1369处病变（平均年龄66±10岁，85%为男性）。近端节段的CTO PCI（n = 633，46%）比中段（n = 557，41%）和远端节段（n = 179，13%）更常见。接受近端节段CTO PCI的患者更可能是吸烟者（P <0.01），有冠状动脉旁路移植术史（P = 0.03）且射血分数较低（P = 0.04）。与中段或远端CTO相比，近端节段发生的CTO长度更长（P <0.01），近端帽模糊（P <0.01），且有中度/重度钙化（P <0.01）。介入侧支在近端节段CTO PCI中更常出现（64%、53%、56%，P <0.01），这与相对于正向导丝升级（67%、82%、82%，P <0.01）逆行途径的更高使用率（47%、33%、37%，P <0.01）一致。近端节段CTO PCI的手术复杂性更高（与中段和远端相比）：造影剂用量 = 275 ml（200 - 375）、260 ml（200 - 350）、250 ml（175 - 350），P = 0.01；透视时间53分钟（32 - 83）、39分钟（24 - 65）、40分钟（22 - 72），P <0.01。然而，手术成功率（87%、90%、85%，P = 0.1）、技术成功率（89%、91%、88%，P = 0.24）和并发症发生率（2.8%、2.5%、2.2%，P = 0.88）并无差异。
结论
CTO PCI最常见的靶血管位置是冠状动脉近端节段。近端闭塞的PCI与不良的临床和血管造影特征相关，且常需使用逆行途径，但可实现较高的手术和技术成功率以及较低的并发症发生率。©2016威利期刊公司
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