Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Texas Health Presbyterian Hospital, Dallas, Texas, USA.
Catheter Cardiovasc Interv. 2023 Nov;102(5):834-843. doi: 10.1002/ccd.30830. Epub 2023 Sep 7.
There is limited data on the use of the balloon-assisted subintimal entry (BASE) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We analyzed the baseline clinical and angiographic characteristics and outcomes of 155 CTO PCIs that utilized the BASE technique at 31 US and non-US centers between 2016 and 2023.
The BASE technique was used in 155 (7.9%) of 1968 antegrade dissection and re-entry (ADR) cases performed during the study period. The mean age was 66 ± 10 years, 88.9% of the patients were men, and the prevalence of diabetes (44.6%), hypertension (90.5%), and dyslipidemia (88.7%) was high. Compared with 1813 ADR cases that did not use BASE, the target vessel of the BASE cases was more commonly the RCA and less commonly the LAD. Lesions requiring BASE had longer occlusion length (42 ± 23 vs. 37 ± 23 mm, p = 0.011), higher Japanese CTO (J-CTO) (3.4 ± 1.0 vs. 3.0 ± 1.1, p < 0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention chronic total occlusion) (1.8 ± 1.0 vs. 1.5 ± 1.0, p = 0.008) scores, and were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Technical (71.6% vs. 75.5%, p = 0.334) and procedural success (71.6% vs. 72.8%, p = 0.821), as well as major adverse cardiac events (MACE) (1.3% vs. 4.1%, p = 0.124), were similar in ADR cases that used BASE and those that did not.
The BASE technique is used in CTOs with longer occlusion length, higher J-CTO score, and more complex angiographic characteristics, and is associated with moderate success but also low MACE.
关于球囊辅助内膜下进入（BASE）技术在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中的应用，数据有限。
我们分析了 2016 年至 2023 年期间，31 个美国和非美国中心的 155 例 CTO PCI 中使用 BASE 技术的患者的基线临床和血管造影特征及结果。
在研究期间，1968 例顺行夹层和再进入（ADR）病例中，有 155 例（7.9%）使用了 BASE 技术。患者平均年龄为 66±10 岁，88.9%为男性，糖尿病（44.6%）、高血压（90.5%）和血脂异常（88.7%）的患病率较高。与未使用 BASE 的 1813 例 ADR 病例相比，BASE 病例的靶血管更常见于 RCA，而较少见于 LAD。需要 BASE 的病变闭塞长度更长（42±23 比 37±23 毫米，p=0.011），日本 CTO（J-CTO）评分（3.4±1.0 比 3.0±1.1，p<0.001）和 PROGRESS-CTO（慢性完全闭塞介入前瞻性全球注册研究慢性完全闭塞）评分（1.8±1.0 比 1.5±1.0，p=0.008）更高，并且更可能存在近端帽模糊、近端帽旁侧支、钝端/无残端、中重度钙化和近端迂曲。ADR 病例中，使用 BASE 的技术成功率（71.6%比 75.5%，p=0.334）和程序成功率（71.6%比 72.8%，p=0.821）以及主要不良心脏事件（MACE）（1.3%比 4.1%，p=0.124）与未使用 BASE 的病例相似。
BASE 技术用于闭塞长度较长、J-CTO 评分较高且血管造影特征较复杂的 CTO，其成功率中等，但 MACE 发生率较低。
