“跷跷板球囊-导丝切割”技术在球囊无法通过的慢性完全闭塞病变中优于Tornus导管。

"Seesaw balloon-wire cutting" technique is superior to Tornus catheter in balloon uncrossable chronic total occlusions.

作者信息

Xue Jingyi, Li Jianqiang, Wang Hongjun, Sheng Li, Gong Yongtai, Sun Danghui, Li Shuang, Li Weimin, Wang Dingyu, Li Yue

机构信息

Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.

Department of Cardiology, The First Hospital of Harbin, Harbin, China.

出版信息

Int J Cardiol. 2017 Feb 1;228:523-527. doi: 10.1016/j.ijcard.2016.10.107. Epub 2016 Nov 2.

DOI:10.1016/j.ijcard.2016.10.107

PMID:27875729

Abstract

BACKGROUND

Inability to advance a balloon is a well-recognized cause leading to a failure in recanalization of chronic total occlusions (CTOs) despite successfully passing a guidewire. A few techniques and devices have been introduced to facilitate balloon passage, especially the use of Tornus catheter. However, complex manipulation, expensive cost, and availability limit the application of these methods. This study was to evaluate the efficiency and safety of "seesaw balloon-wire cutting" technique in comparison with Tornus catheter for balloon uncrossable CTOs.

METHODS

Eighty patients with balloon uncrossable CTOs were enrolled in this study. Among them, 40 patients treated with "seesaw balloon-wire cutting" technique were consecutively investigated and 40 patients treated with Tornus catheter before were matched retrospectively. A rotablator or retrograde strategy was taken as a bail-out strategy. Success rates of device and procedure and complication rate were assessed. Complications included coronary dissection, cardiac tamponade, death, Q-wave myocardial infarction (MI), non-Q-wave MI, emergency PCI and bypass surgery.

RESULTS

Compared with the Tornus catheter, device success rate was significantly higher with the "seesaw balloon-wire cutting" technique (87.5% vs. 45.0%, P<0.001), and the mean procedural time was much shorter (90.5±8.3min vs. 141.5±21.3min, P<0.001). The procedural success rate was also higher with the "seesaw balloon-wire cutting" technique (92.5% vs.72.5%, P=0.037). There were no differences in complication rate.

CONCLUSION

The "seesaw balloon-wire cutting" technique is superior to the Tornus catheter in treating balloon uncrossable CTOs.

摘要

背景

尽管导丝已成功通过，但球囊无法推进是导致慢性完全闭塞病变（CTO）再通失败的一个公认原因。已经引入了一些技术和器械来促进球囊通过，尤其是Tornus导管的使用。然而，复杂的操作、高昂的成本和可及性限制了这些方法的应用。本研究旨在评估“跷跷板球囊-导丝切割”技术与Tornus导管相比，用于球囊无法通过的CTO的有效性和安全性。

方法

本研究纳入了80例球囊无法通过的CTO患者。其中，连续研究了40例采用“跷跷板球囊-导丝切割”技术治疗的患者，并对40例之前采用Tornus导管治疗的患者进行回顾性匹配。采用旋磨术或逆行策略作为补救策略。评估器械成功率、手术成功率和并发症发生率。并发症包括冠状动脉夹层、心脏压塞、死亡、Q波心肌梗死（MI）、非Q波MI、急诊经皮冠状动脉介入治疗（PCI）和搭桥手术。

结果

与Tornus导管相比，“跷跷板球囊-导丝切割”技术的器械成功率显著更高（87.5%对45.0%，P<0.001），平均手术时间更短（90.5±8.3分钟对141.5±21.3分钟，P<0.001）。“跷跷板球囊-导丝切割”技术的手术成功率也更高（92.5%对72.5%，P=0.037）。并发症发生率无差异。