Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
Cardiovasc Interv Ther. 2021 Jan;36(1):67-73. doi: 10.1007/s12928-020-00647-5. Epub 2020 Feb 12.
The technical outcome of poor distal vessel quality (PDV) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is yet to be clearly elucidated. PDV has not been evaluated in scoring systems. We examined 193 consecutive CTO-PCIs performed in January 2013-December 2017. The endpoint, including the technical outcomes in these patients between with and without PDV, was analyzed. Moreover, we re-evaluated the predictors for CTO-PCI difficulty according to Japan-CTO score. Out of 193 CTO-PCIs, 181 (93.8%) achieved technical success [including 101 (55.8%) with and 80 (44.2%) without PDV]. In patients with and without PDV, the success rates of guidewire crossing using only the antegrade technique were 46.5% vs. 83.8%, respectively (p < 0.0001) and using the retrograde approach were 53.5% vs. 16.3%, respectively (p < 0.0001). Moreover, there were 56 non-interventional collateral channels in 181 patients. The successful rate of primary antegrade approach was significantly lower and the rate of a rescue retrograde approach was significantly higher with PDV (37.2% vs. 62.8%, 76.9% vs. 23.1%, respectively; p < 0.0119). Significant predictors associated with successful guidewire crossings of ≤ 30 min included blunt stump, calcification, bending, occlusion length ≥ 20 mm, retry lesion following Japan-CTO score, and PDV (p < 0.05, all). Multivariate analyses demonstrated that blunt stump, calcification, bending, retry lesion, and PDV were independent predictors of unsuccessful guidewire crossing of ≤ 30 min (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.71, p = 0.0039; OR 0.34, 95% CI 0.16-0.71, p = 0.0035; OR 0.17, 95% CI 0.05-0.60, p = 0.0034; OR 0.18, 95% CI 0.06-0.54, p = 0.0008; and OR 0.19, 95% CI 0.09-0.41, p < 0.0001, respectively). PDV could affect the technical outcome of CTO-PCI.
慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中远端血管质量（PDV）差的技术结果尚不清楚。PDV 尚未在评分系统中进行评估。我们检查了 2013 年 1 月至 2017 年 12 月连续进行的 193 例 CTO-PCI。分析了这些患者中 PDV 有和无的技术结果终点。此外，我们根据日本 CTO 评分重新评估了 CTO-PCI 难度的预测因素。在 193 例 CTO-PCI 中，181 例（93.8%）达到技术成功[包括 101 例（55.8%）有 PDV 和 80 例（44.2%）无 PDV]。在有和无 PDV 的患者中，仅使用正向技术的导丝通过成功率分别为 46.5%比 83.8%（p<0.0001），使用逆行技术的成功率分别为 53.5%比 16.3%（p<0.0001）。此外，181 例患者中有 56 个非介入性侧支通道。PDV 时正向初始方法的成功率明显较低，而逆行方法的成功率明显较高（37.2%比 62.8%，76.9%比 23.1%；p<0.0119）。与导丝≤30min 成功通过相关的显著预测因素包括钝性残端、钙化、弯曲、闭塞长度≥20mm、根据日本 CTO 评分进行的再尝试病变以及 PDV（p<0.05，均）。多变量分析表明，钝性残端、钙化、弯曲、再尝试病变和 PDV 是导丝≤30min 未能成功通过的独立预测因素（比值比[OR]0.31，95%置信区间[CI]0.13-0.71，p=0.0039；OR 0.34，95%CI 0.16-0.71，p=0.0035；OR 0.17，95%CI 0.05-0.60，p=0.0034；OR 0.18，95%CI 0.06-0.54，p=0.0008；OR 0.19，95%CI 0.09-0.41，p<0.0001）。PDV 可能会影响 CTO-PCI 的技术结果。
