Zhang Xiao-Jiao, Zhang Zhan-Xiu, Wang Yong, Hou Pei-Pei, Mu Da-Ming, Wang Cheng-Fu, Luo De-Feng, Chen Bao-Jun, Hou Ai-Jie, Luan Bo
Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, China.
Department of Cardiology, The Second People's Hospital of Huludao, Huludao, China.
J Interv Cardiol. 2021 Feb 10;2021:8893946. doi: 10.1155/2021/8893946. eCollection 2021.
To assess the effectiveness and safety of ARW for vascular recanalization in CTO patients.
Chronic total occlusion (CTO) of coronary artery accompanied with large branch distal to the occluded segment (<2 mm) is one of the challenges physicians are facing during the coronary intervention. In cases where the antegrade wire passed the occluded segment reaching the branch vessel, but could not access the main vessel through various adjustments, application of active antegrade reverse wire technique (ARW) could be considered. . A total of 301 consecutive CTO patients who received the antegrade percutaneous coronary intervention (PCI) between December 2015 and December 2019 at our institution were included, of whom 11 were treated with ARW (10 successfully) for vascular recanalization. The applicability and safety of ARW were assessed.
Among the 301 CTO patients who received antegrade vascular recanalization, 11 were treated with ARW. ARW was successful in 10 patients as follows: from the diagonal branch (D) to anterior descending branch (LAD) in 4 patients; from the septal branch (S) to LAD in 1 patient; from D to S and LAD in 1 patient; from the circumflex branch (LCX) to obtuse marginal branch (OM) in 1 patient; from OM to LCX in 1 patient; from a posterior descending artery (PDA) to the posterior lateral vein (PLV) in 2 patients. Yet, ARW in patient with RCAm CTO failed, while the consequent retrograde PCI succeeded. The mean J-CTO score of the 11 patients was 2.7 ± 0.65, among whom eight were accompanied with calcifications. Sion Black and Fielder XTR reverse wires were used in 9 and 2 patients, respectively. No loss of side branches or severe procedure-related complications occurred in 11 patients.
Therefore, ARW can improve procedural efficiency and should be popularized for further application.
评估主动正向逆向导丝技术（ARW）用于冠状动脉慢性完全闭塞（CTO）患者血管再通的有效性和安全性。
冠状动脉慢性完全闭塞且闭塞段远端大分支直径<2mm是冠状动脉介入治疗中医生面临的挑战之一。当正向导丝穿过闭塞段到达分支血管，但通过各种调整无法进入主血管时，可考虑应用主动正向逆向导丝技术（ARW）。纳入了2015年12月至2019年12月在我院接受正向经皮冠状动脉介入治疗（PCI）的301例连续CTO患者，其中11例接受ARW治疗血管再通（10例成功）。评估了ARW的适用性和安全性。
在301例接受正向血管再通的CTO患者中，11例接受了ARW治疗。10例患者ARW成功，情况如下：4例从对角支（D）至前降支（LAD）；1例从间隔支（S）至LAD；1例从D至S和LAD；1例从回旋支（LCX）至钝缘支（OM）；1例从OM至LCX；2例从后降支（PDA）至后外侧静脉（PLV）。然而，右冠状动脉慢性完全闭塞患者的ARW失败，但随后的逆向PCI成功。11例患者的平均J-CTO评分为2.7±0.65，其中8例伴有钙化。分别有9例和2例患者使用了SION Black和Fielder XTR逆向导丝。11例患者未发生侧支血管丢失或严重的手术相关并发症。
因此，ARW可提高手术效率，应推广进一步应用。
