Xu Rende, Song Xiaoyue, Chang Shufu, Qin Qing, Li Chenguang, Fu Mingqiang, Ren Daoyuan, Ge Lei, Qian Juying, Ma Jianying, Ge Junbo
Department of Cardiology, 92323Zhongshan Hospital, Fudan University, Shanghai, China.
Angiology. 2021 Jan;72(1):44-49. doi: 10.1177/0003319720949312. Epub 2020 Aug 17.
Coronary chronic total occlusions (CTOs) are characterized by a high incidence of severe plaque calcifications, which are associated with a high use of the retrograde approach and a low success rate of percutaneous coronary intervention (PCI). However, the feasibility of rotational atherectomy (RA) in retrograde CTO-PCI remains unknown. The aim of the present study is to examine the safety and efficacy of RA in retrograde CTO-PCI. Consecutive patients (n = 129) who underwent RA during CTO-PCI were categorized into anterograde and retrograde groups according to the CTO crossing approach. The distributions of the baseline characteristics were similar in the 2 groups, but the lesion type was more complex ( = .001), and the starting burr size was smaller ( = .003) in the retrograde group than in the anterograde group. There was a trend of a higher incidence of procedural complications in the retrograde group than in the anterograde group ( = .054). Technical and procedural success and in-hospital outcomes were not significantly different between the 2 groups. In conclusion, RA was feasible in retrograde CTO PCI, but some specific precautions are required before and during the procedure. In addition, further investigation of the long-term outcomes of RA in retrograde CTO PCI is necessary.
冠状动脉慢性完全闭塞（CTO）的特点是严重斑块钙化的发生率很高，这与逆行途径的高使用率和经皮冠状动脉介入治疗（PCI）的低成功率相关。然而，旋磨术（RA）在逆行CTO-PCI中的可行性仍然未知。本研究的目的是探讨RA在逆行CTO-PCI中的安全性和有效性。根据CTO通过途径，将在CTO-PCI期间接受RA的连续患者（n = 129）分为顺行组和逆行组。两组的基线特征分布相似，但逆行组的病变类型比顺行组更复杂（P = .001），起始磨头尺寸更小（P = .003）。逆行组的手术并发症发生率有高于顺行组的趋势（P = .054）。两组之间的技术和手术成功率以及住院结局无显著差异。总之，RA在逆行CTO PCI中是可行的，但在手术前和手术期间需要采取一些特定的预防措施。此外，有必要进一步研究RA在逆行CTO PCI中的长期结局。
