Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
Interventional Cardiology Unit, North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
Catheter Cardiovasc Interv. 2018 Sep 1;92(3):466-476. doi: 10.1002/ccd.27472. Epub 2018 Jan 4.
To evaluate the outcomes of subadventitial stenting (SS) around occluded stents for recanalizing in-stent chronic total occlusions (IS-CTOs).
There is little evidence on the outcomes of SS for IS-CTO.
We examined the outcomes of SS for IS-CTO PCI at 14 centers between July 2011 and June 2017, and compared them to historical controls recanalized using within-stent stenting (WSS). Target-vessel failure (TVF) on follow-up was the endpoint of this study, and was defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.
During study period, 422 IS-CTO PCIs were performed, of which 32 (7.6%) were recanalized with SS, usually when conventional approaches failed. The most frequent CTO vessel was the right coronary artery (72%). Mean J-CTO score was 3.1 ± 0.9. SS was antegrade in 53%, and retrograde in 47%. Part of the occluded stent was crushed in 37%, while the whole stent was crushed in 63%. Intravascular imaging was used in 59%. One patient (3.1%) suffered tamponade. Angiographic follow-up was performed in 10/32 patients: stents were patent in six cases, one had mild neointimal hyperplasia, and three had severe restenosis at the SS site. Clinical follow-up was available for 29/32 patients for a mean of 388 ± 303 days. The 24-month incidence of TVF was 13.8%, which was similar to historical controls treated with WSS (19.5%, P = 0.49).
SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted.
评估血管外膜下支架术（SS）治疗闭塞支架内慢性完全闭塞（IS-CTO）再通的结果。
关于 SS 治疗 IS-CTO 的结果证据很少。
我们检查了 2011 年 7 月至 2017 年 6 月期间在 14 个中心进行的 IS-CTO PCI 的 SS 结果，并将其与使用支架内支架（WSS）再通的历史对照进行了比较。随访时的靶血管失败（TVF）是本研究的终点，定义为心脏死亡、靶血管心肌梗死和靶血管血运重建的复合事件。
研究期间共进行了 422 例 IS-CTO PCI，其中 32 例（7.6%）采用 SS 成功再通，通常是在常规方法失败后进行的。最常见的 CTO 血管是右冠状动脉（72%）。平均 J-CTO 评分为 3.1±0.9。SS 顺行 53%，逆行 47%。37%的闭塞支架部分被压碎，63%的支架完全被压碎。59%的患者使用血管内成像。1 例患者（3.1%）发生心脏压塞。10/32 例患者进行了血管造影随访：6 例支架通畅，1 例轻度新生内膜增生，3 例 SS 部位严重再狭窄。29/32 例患者获得临床随访，平均随访时间为 388±303 天。24 个月 TVF 的发生率为 13.8%，与接受 WSS 治疗的历史对照（19.5%，P=0.49）相似。
SS 很少进行，通常作为最后手段用于治疗复杂的 IS-CTO。它具有良好的急性和中期结果，但由于本研究的样本量较小，需要进一步研究。
