Karacsonyi Judit, Kostantinis Spyridon, Simsek Bahadir, Rempakos Athanasios, Allana Salman S, Alaswad Khaldoon, Krestyaninov Oleg, Khatri Jaikirshan, Poommipanit Paul, Jaffer Farouc A, Choi James, Patel Mitul, Gorgulu Sevket, Koutouzis Michalis, Tsiafoutis Ioannis, Sheikh Abdul M, ElGuindy Ahmed, Elbarouni Basem, Patel Taral, Jefferson Brian, Wollmuth Jason R, Yeh Robert, Karmpaliotis Dimitrios, Kirtane Ajay J, McEntegart Margaret B, Masoumi Amirali, Davies Rhian, Rangan Bavana V, Mastrodemos Olga C, Doshi Darshan, Sandoval Yader, Basir Mir B, Megaly Michael S, Ungi Imre, Abi Rafeh Nidal, Goktekin Omer, Brilakis Emmanouil S
Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA.
J Pers Med. 2023 Mar 13;13(3):515. doi: 10.3390/jpm13030515.
Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, < 0.001) and diabetes mellitus (50% vs. 42%, < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. < 0.001), moderate/severe calcification (68% vs. 40%, < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, < 0.001) and procedural (88% vs. 96%, < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, < 0.001). Several techniques were required for balloon uncrossable lesions. In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
球囊无法通过的病变被定义为在导丝成功通过后球囊无法通过的病变。我们分析了2012年至2022年期间在41个中心进行的8671例慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中球囊无法通过的病变与手术结果之间的关联。球囊无法通过的病变的患病率为9.2%。患者的平均年龄为64.2±10岁，80%为男性。与球囊可通过病变的患者相比，球囊无法通过病变的患者年龄更大（67.3±9岁对63.9±10岁，P<0.001），更有可能接受过冠状动脉旁路移植手术（40%对25%，P<0.001）和患有糖尿病（50%对42%，P<0.001）。支架内再狭窄（23%对16%，P<0.001）、中度/重度钙化（68%对40%，P<0.001）和中度/重度近端血管迂曲（36%对25%，P<0.001）在球囊无法通过的病变中更为常见。球囊无法通过的病变的手术时间更长（132（90，197）分钟对109（71，160）分钟，P<0.001），空气比释动能辐射剂量更高（2.55（1.41，4.23）对1.97（1.10，3.40）分钟，P<0.001），而这些病变的技术成功率（91%对99%，P<0.001）和手术成功率（88%对96%，P<0.001）较低，主要不良心脏事件（MACE）发生率较高（3.14%对1.49%，P<0.001）。球囊无法通过的病变需要多种技术。在一个当代多中心注册研究中，9.2%成功通过的CTO最初是球囊无法通过的。与球囊可通过的病变相比，球囊无法通过的病变的技术和手术成功率较低，并发症风险较高。
