Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
J Interv Cardiol. 2021 Apr 20;2021:8835104. doi: 10.1155/2021/8835104. eCollection 2021.
The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures.
Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed.
The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups.
Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.
经验丰富的术者进行冠状动脉慢性完全闭塞（CTO）开通的初始再通率>85%，但仅有 10%的先前失败的 CTO 患者接受再尝试血运重建。本回顾性研究分析了先前失败后再次尝试经皮冠状动脉介入治疗（PCI）治疗 CTO 的成功率和策略。
共有 206 例 212 处 CTO 患者纳入研究。所有先前血运重建失败的患者均于 2015 年 1 月至 2019 年 3 月在复旦大学附属中山医院接受再次尝试 PCI。收集临床因素（年龄、性别、合并症、左心室射血分数、吸烟史和血运重建情况）、CTO 的血管造影特征（病变靶血管、日本 CTO 评分、CTO 病变形态和侧支循环评分）、策略（手术方法和器械的使用）和主要不良事件等数据。
纳入患者的平均年龄为 60.96±12.36 岁，男性占 90.3%。47.1%的患者有心肌梗死病史，70.4%的患者有支架植入史，支架内闭塞率为 6.6%。CTO 主要位于左前降支（43.9%）和右冠状动脉（43.9%）。80.7%的病变为极难开通（J-CTO 评分≥3），总体成功率为 81.1%。多变量回归分析显示，J-CTO 评分、侧支循环评分、冠状动脉多排螺旋 CT 血管造影、双造影剂注射、血管内超声、主动迎接技术、平行导丝技术和 CTO 形态是再通成功的预测因素。最终再通成功组和失败组的手术并发症发生率无显著差异。
对于高容量 CTO 术者和多次尝试后，开通复杂 CTO 与高成功率和低并发症发生率相关。
