Xenogiannis Iosif, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Patel Mitul, Mahmud Ehtisham, Choi James W, Burke M Nicholas, Doing Anthony H, Dattilo Phil, Toma Catalin, Smith A J Conrad, Uretsky Barry, Krestyaninov Oleg, Khelimskii Dmitrii, Holper Elizabeth, Potluri Srinivasa, Wyman R Michael, Kandzari David E, Garcia Santiago, Koutouzis Michalis, Tsiafoutis Ioannis, Jaber Wissam, Samady Habib, Moses Jeffrey W, Lembo Nicholas J, Parikh Manish, Kirtane Ajay J, Ali Ziad A, Doshi Darshan, Tajti Peter, Rangan Bavana V, Abdullah Shuaib, Banerjee Subhash, Brilakis Emmanouil S
Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.
J Invasive Cardiol. 2019 Jan;31(1):27-34. doi: 10.25270/jic/18.00195. Epub 2018 Nov 11.
The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study.
We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry.
Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07).
Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.
逆行慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中最常用的重回技术是逆向控制顺行和逆行内膜下寻径（rCART）。使用导引导管延长装置可促进rCART操作，但相关研究有限。
在一个当代多中心CTO-PCI注册研究中，我们比较了成功逆行开通CTO的患者中，传统rCART、导引导管延长rCART以及两种技术联合使用（联合rCART）的临床和操作特征及结果。
2012年至2018年期间，1336例逆行CTO-PCI病例中有467例使用了rCART。60/467例（13%）使用了导引导管延长rCART（使用率从2012年的0%增至2017年的26%）。传统rCART组、导引导管延长rCART组和联合rCART组的靶病变J-CTO评分相似（分别为3.3±1.1、3.2±1.2和3.6±0.8；P=0.28），技术成功率相似（分别为99%、100%和96.4%；P=0.36），手术成功率相似（分别为93.2%、93.8%和96.3%；P=0.82），院内主要不良心脏事件（MACE）发生率相似（分别为6.4%、9.4%和3.6%；P=0.66）。联合rCART组的总手术时间更长（分别为196分钟[四分位间距，146 - 256分钟]、200分钟[四分位间距，164 - 293分钟]和255分钟[四分位间距，195 - 280分钟]；P<0.01），导引导管延长组患者的空气比释动能辐射剂量有降低趋势（分别为4.11戈瑞[四分位间距，2.49 - 5.77戈瑞]、3.19戈瑞[四分位间距，1.29 - 4.74戈瑞]和3.47戈瑞[四分位间距，2.89 - 5.56戈瑞]；P=0.07）。
导引导管延长rCART越来越多地用于逆行开通CTO，其成功率和MACE发生率与传统rCART相似。
