Tajti Peter, Karatasakis Aris, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Patel Mitul, Mahmud Ehtisham, Choi James W, Doing Anthony H, Toma Catalin, Uretsky Barry, Garcia Santiago, Moses Jeffrey W, Parikh Manish, Kirtane Ajay, Ali Ziad A, Hatem Raja, Karacsonyi Judit, Danek Barbara A, Rangan Bavana V, Banerjee Subhash, Ungi Imre, Brilakis Emmanouil S
Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.
J Invasive Cardiol. 2018 Mar;30(3):89-96. Epub 2017 Nov 15.
Retrograde percutaneous coronary intervention (PCI) of native coronary artery chronic total occlusion (CTO) via left internal mammary artery (LIMA) graft has received limited study.
We compared the clinical and procedural characteristics and outcomes of retrograde CTO-PCI through LIMA grafts vs other conduits in a contemporary multicenter CTO registry. The LIMA was used as the collateral channel in 20 of 990 retrograde CTO-PCIs (2.02%) performed at 18 United States centers. The mean age of the study patients was 69 ± 7 years and 95% were men. The most common CTO target vessel was the right coronary artery (55%). The mean J-CTO score in the LIMA group was high (3.45 ± 0.76). The technical success rates were 70% for retrograde PCI via LIMA graft vs 81.05% for retrograde via other conduits (P=.25), while procedural success rates were 70% for retrograde PCI via LIMA graft and 78.19% for retrograde via other conduits (P=.41). The incidence of major in-hospital complications was also similar between the LIMA and non-LIMA retrograde groups (5% vs 6%; P>.99). Use of guide-catheter extensions (40% vs 28%; P=.22), intravascular ultrasound (45% vs 31%; P=.20), and left ventricular assist devices (24% vs 10%; P=.08) was numerically higher in retrograde CTO-PCIs via LIMA grafts.
Retrograde CTO-PCI is infrequently performed via LIMA grafts and is associated with similar success and major in-hospital complication rates as retrograde CTO-PCI performed via other conduits.
经左乳内动脉（LIMA）桥血管对自身冠状动脉慢性完全闭塞（CTO）病变进行逆向经皮冠状动脉介入治疗（PCI）的研究较少。
在一个当代多中心CTO注册研究中，我们比较了经LIMA桥血管与经其他血管进行逆向CTO-PCI的临床、操作特征及结果。在美国18个中心进行的990例逆向CTO-PCI中，有20例（2.02%）使用LIMA作为侧支通道。研究患者的平均年龄为69±7岁，95%为男性。最常见的CTO靶血管为右冠状动脉（55%）。LIMA组的平均J-CTO评分较高（3.45±0.76）。经LIMA桥血管逆向PCI的技术成功率为70%，经其他血管逆向PCI的技术成功率为81.05%（P=0.25），而经LIMA桥血管逆向PCI的操作成功率为70%，经其他血管逆向PCI的操作成功率为78.19%（P=0.41）。LIMA逆向组与非LIMA逆向组的院内主要并发症发生率也相似（5%对6%；P>0.99）。经LIMA桥血管进行逆向CTO-PCI时，使用导引导管延长装置（40%对28%；P=0.22）、血管内超声（45%对31%；P=0.20）和左心室辅助装置（24%对10%；P=0.08）的比例在数值上更高。
经LIMA桥血管进行逆向CTO-PCI的情况较少见，其成功率和院内主要并发症发生率与经其他血管进行逆向CTO-PCI相似。
