Center of Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas.
Am J Cardiol. 2023 Nov 15;207:305-313. doi: 10.1016/j.amjcard.2023.08.155. Epub 2023 Sep 28.
We examined the outcomes of the Carlino technique in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). We analyzed the baseline clinical and angiographic characteristics and outcomes of 128 CTO PCIs that included the Carlino technique at 22 US and no-US centers between 2016 and 2023. The Carlino technique was used in 128 (2.8%) of 4,508 cases that used anterograde dissection and reentry (78.9%) or the retrograde approach (21.1%) during the study period, and it increased steadily over time (from 0.0% in 2016 to 8.3% in 2023). The mean patient age was 65.6 ± 9.7 years, and 88.7% of the patients were men with high prevalence of hypertension (89.1%) and dyslipidemia (80.2%). The Carlino technique was more commonly used in cases with moderate to severe calcification (77.2% vs 55.5%, p <0.001) with higher J-CTO (3.3 ± 0.9 vs 3.0 ± 1.1, p = 0.007), Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) (1.7 ± 1.0 vs 1.4 ± 1.0, p = 0.001), PROGRESS-CTO Mortality (2.6 ± 0.9 vs 2.0 ± 0.9, p = 0.013) and PROGRESS-CTO Perforation (3.7 ± 1.1 vs 3.5 ± 1.0, p = 0.029) scores. Carlino cases had longer procedure and fluoroscopy time, and higher contrast volume and radiation dose. Carlino cases had lower technical (65.6% vs 78.5%, p <0.001) and procedural (63.3% vs 76.3%, p <0.001) success, similar major adverse cardiac events (6.2% vs 3.2%, p = 0.101) and higher incidence of pericardiocentesis (3.9% vs 1.3%, p = 0.042), perforation (18.0% vs 8.9%, p = 0.001) and contrast-induced acute kidney injury (2.3% vs 0.4%, p = 0.012). The Carlino technique was associated with higher procedural success when used for retrograde crossing (81.5% vs 58.4%, p = 0.047). The Carlino technique is increasingly being used in CTO PCI especially for higher complexity lesions.
我们研究了 Carlino 技术在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中的结果。我们分析了 2016 年至 2023 年期间 22 个美国和非美国中心的 128 例 CTO PCI 中 Carlino 技术的基线临床和血管造影特征及结果。在研究期间，Carlino 技术在使用顺行夹层和再进入（78.9%）或逆行方法（21.1%）的 4508 例病例中的 128 例（2.8%）中使用，并且该技术的使用比例随着时间的推移而稳步增加（从 2016 年的 0.0%增加到 2023 年的 8.3%）。患者平均年龄为 65.6±9.7 岁，88.7%的患者为男性，高血压（89.1%）和血脂异常（80.2%）的患病率较高。Carlino 技术更常用于中度至重度钙化的病例（77.2%比 55.5%，p<0.001），J-CTO 评分更高（3.3±0.9 比 3.0±1.1，p=0.007），全球前瞻性慢性完全闭塞介入研究登记处（PROGRESS-CTO）评分（1.7±1.0 比 1.4±1.0，p=0.001），PROGRESS-CTO 死亡率（2.6±0.9 比 2.0±0.9，p=0.013）和 PROGRESS-CTO 穿孔（3.7±1.1 比 3.5±1.0，p=0.029）评分更高。Carlino 病例的手术和透视时间较长，造影剂用量和辐射剂量较高。Carlino 病例的技术成功率（65.6%比 78.5%，p<0.001）和手术成功率（63.3%比 76.3%，p<0.001）较低，主要不良心脏事件发生率（6.2%比 3.2%，p=0.101）和心包穿刺术（3.9%比 1.3%，p=0.042）、穿孔（18.0%比 8.9%，p=0.001）和对比剂诱导的急性肾损伤（2.3%比 0.4%，p=0.012）发生率较高。逆行交叉时使用 Carlino 技术与更高的手术成功率相关（81.5%比 58.4%，p=0.047）。Carlino 技术越来越多地用于 CTO PCI，特别是用于更高复杂性病变。
