“球囊无法扩张型”慢性完全闭塞病变的患病率、临床表现及治疗：来自美国多中心注册研究的见解
Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry.
作者信息
Tajti Peter, Karmpaliotis Dimitri, Alaswad Khaldoon, Toma Catalin, Choi James W, Jaffer Farouc A, Doing Anthony H, Patel Mitul, Mahmud Ehtisham, Uretsky Barry, Karatasakis Aris, Karacsonyi Judit, Danek Barbara A, Rangan Bavana V, Banerjee Subhash, Ungi Imre, Brilakis Emmanouil S
机构信息
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
出版信息
Catheter Cardiovasc Interv. 2018 Mar 1;91(4):657-666. doi: 10.1002/ccd.27510. Epub 2018 Jan 23.
BACKGROUND
The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study.
METHODS
We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry.
RESULTS
Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%).
CONCLUSIONS
Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.
背景
球囊无法扩张的慢性完全闭塞病变（CTO）的患病率、治疗及预后研究有限。
方法
我们在美国当代多中心注册研究中，研究了球囊无法扩张的CTO经皮冠状动脉介入治疗（PCI）的患病率、临床和血管造影特征以及手术结果。
结果
2012年至2017年期间，415例导丝通过成功的患者连续425例CTO PCI中有球囊无法扩张病变的数据：425例CTO中有52例球囊无法扩张（12%）。患者平均年龄为65±10岁，大多数患者为男性（84%）。球囊无法扩张的CTO患者更易患糖尿病（67%对41%，P<0.001）和心力衰竭（44%对28%，P=0.027）。球囊无法扩张的CTO更长（40mm[四分位间距，IQR 20 - 50]对30[IQR 15 - 40]，P=0.016），更易有中度/重度钙化（87%对54%，P<0.001），且J-CTO评分更高（3.2±1.1对2.5±1.3，P<0.001）和PROGRESS-CTO并发症评分更高（3.9±1.7对3.1±2.0，P<0.005）。它们与较低的技术成功率和手术成功率相关（分别为92%对98%，P=0.024；88%对96%，P=0.034），且因穿孔率较高，住院期间发生主要不良事件的风险更高（8%对2%，P=0.008）。球囊无法扩张的CTO最常用的治疗方法是高压球囊扩张（64%）、旋磨术（31%）、激光治疗（21%）和切割球囊（15%）。
结论
球囊无法扩张的CTO很常见，且与较低的成功率和较高的并发症发生率相关。
Zotero 插件