Zhou You, Deng Lixiang, Wang Zhe, Hu Yiqing, Chen Zhangwei, Lu Hao, Qian Juying, Ge Junbo
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; National Clinical Research Center for Interventional Medicine; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, 200032, People's Republic of China.
J Multidiscip Healthc. 2023 Aug 25;16:2463-2470. doi: 10.2147/JMDH.S425489. eCollection 2023.
The tip-in technique, which involves advancing an antegrade microcatheter cross the lesion over a retrograde guidewire, is an elaborated maneuver in the recanalization of coronary chronic total occlusion (CTO). We seek to assess the efficiency of a guide extension catheter-facilitated tip-in technique in comparison to the traditional retrograde approach, which is accomplished by an externalization wire.
Thirty-three CTO patients successfully revascularized using guide extension catheter-facilitated "tip-in" were included and matched with another 33 patients by J-CTO score and operators, whose CTO was recanalized using an externalized wire. The manipulation time from the first retrograde wire entering the antegrade guide to the first antegrade balloon inflation in the occlusion was calculated.
Compared with the wire-externalization group, the manipulation time in the tip-in group was significantly shortened [389s; interquartile range (IQR), 272-478 vs 706s; IQR, 560-914; p < 0.001]. There was a trend in decreasing total operation time and radiation dose, but it did not reach statistical significance.
Guide extension catheter-facilitated tip-in is an efficient method to achieve the recanalization of CTO in a retrograde way, which would be pivotal when the retrograde microcatheter could not be advanced into the antegrade guide catheter.
“插入技术”是指将顺行微导管越过逆行导丝推进至病变部位，是冠状动脉慢性完全闭塞（CTO）再通术中一种精细的操作方法。我们旨在评估与传统逆行方法（通过外部化导丝完成）相比，使用导引导管延伸导管辅助的插入技术的效率。
纳入33例使用导引导管延伸导管辅助“插入”技术成功实现血运重建的CTO患者，并根据J-CTO评分和术者与另外33例使用外部化导丝实现CTO再通的患者进行匹配。计算从第一根逆行导丝进入顺行导引导管到闭塞病变处首次顺行球囊扩张的操作时间。
与导丝外部化组相比，插入组的操作时间显著缩短[389秒；四分位数间距（IQR），272 - 478秒 vs 706秒；IQR，560 - 914秒；p < 0.001]。总手术时间和辐射剂量有下降趋势，但未达到统计学意义。
导引导管延伸导管辅助的插入技术是一种有效的逆行CTO再通方法，当逆行微导管无法推进至顺行导引导管时，该技术将起关键作用。
