Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Columbia University, New York, New York.
Am J Cardiol. 2019 May 1;123(9):1422-1428. doi: 10.1016/j.amjcard.2019.01.054. Epub 2019 Feb 11.
There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，关于使用旋切术的数据有限。我们比较了在一个当代多中心 CTO PCI 注册研究中，使用和不使用旋切术进行 CTO PCI 的临床和手术特征及结局。2012 年至 2018 年，21 个参与中心共进行了 3607 例 CTO PCI。117 例（3.2%）使用了旋切术：105 例使用旋磨术，8 例使用轨道旋切术，4 例同时使用两种方法。使用旋切术的患者年龄较大（68±8 岁 vs 64±10 岁，p<0.0001），日本 CTO 评分较高（3.0±1.2 vs 2.4±1.3，p<0.0001）。使用旋切术的 CTO PCI 病例在技术成功率（91% vs 87%，p=0.240）和手术成功率（90% vs 85%，p=0.159）方面相似，院内主要不良心脏事件（4% vs 3%，p=0.382）发生率也相似。然而，旋切术病例与更高的供血管损伤发生率（4% vs 1%，p=0.031）、需要心包穿刺引流的心包填塞（2.6% vs 0.4%，p=0.012）和更常需要使用左心室辅助装置（9% vs 5%，p=0.031）相关。旋切术病例的手术时间更长（196[141,247] vs 119[76,180]分钟，p<0.0001），患者空气比释动能辐射剂量更高（3.6[2.5,5.6] vs 2.8[1.6,4.7] Gray，p=0.001）。总之，目前约有 3%的 CTO PCI 病例使用旋切术，与技术和手术成功率以及总体主要不良心脏事件发生率相似，但供血管损伤和心包填塞的风险更高。
