Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.
National Clinical Research Center for Interventional Medicine, Shanghai, China.
Catheter Cardiovasc Interv. 2023 Dec;102(7):1210-1221. doi: 10.1002/ccd.30889. Epub 2023 Oct 23.
The predictors of success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) through antegrade dissection and re-entry (ADR) using the Stingray system (Stingray ADR) remain elusive, mainly owing to the lack of consecutive angiographic and procedural records of patients.
This study aimed to identify indicators that can determine the success of CTO PCI performed using the Stingray ADR technique.
The clinical data of 115 patients who underwent CTO PCI through Stingray ADR at the same cardiac center were retrospectively and consecutively collected. Multivariate logistic regression analysis was performed to investigate the indicators of the success of ADR attempts.
The technical success rate of Stingray ADR in CTO PCI was 72.2%. The overall technical success rate of CTO recanalization was 78.3% in all CTO PCIs having used Stingray Low Profile balloon. Vessel calcification (odds ratio [OR]: 4.03; 95% confidence interval [CI]: 1.49-11.88; p = 0.008), and retrograde puncture indicator (OR: 4.89; 95% CI: 1.51-17.11; p = 0.009) were identified as independent positive predictors. Blunt/no stump proximal to the occlusion segment (OR: 0.22; 95% CI: 0.06-0.64; p = 0.009), decision time before Stingray ADR (per 1 h increase) (OR: 0.54; 95% CI: 0.31-0.92; p = 0.026), operation duration of Stingray ADR (per 10 min increase) (OR: 0.62; 95% CI: 0.40-0.94; p = 0.028), and puncture site at the intraplaque region (OR: 0.24; 95% CI: 0.06-0.84; p = 0.026) were identified as the four negative independent predictors.
This study revealed independent predictors of the success of CTO PCI performed using the Stingray ADR technique. As for CTO characteristics, the presence of calcification in the CTO segment and a tapered stump proximal to the lesion site can facilitate successful Stingray ADR. As for the procedures, the success rate of Stingray ADR can be improved by initiating the technique decisively and promptly, operating the system quickly and accurately and creating a puncture in the distal cap region of CTO under retrograde guidance.
使用 Stingray 系统（Stingray ADR）进行经正向夹层和再进入（ADR）的慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成功预测因素仍难以确定，主要是因为缺乏患者连续的血管造影和手术记录。
本研究旨在确定可确定使用 Stingray ADR 技术进行 CTO PCI 成功的指标。
回顾性连续收集在同一心脏中心接受 Stingray ADR 治疗的 115 例 CTO PCI 患者的临床资料。采用多变量逻辑回归分析探讨 ADR 尝试的成功指标。
CTO PCI 中 Stingray ADR 的技术成功率为 72.2%。所有使用 Stingray Low Profile 球囊进行 CTO PCI 的患者中，CTO 再通的总体技术成功率为 78.3%。血管钙化（比值比 [OR]：4.03；95%置信区间 [CI]：1.49-11.88；p=0.008）和逆行穿刺指标（OR：4.89；95% CI：1.51-17.11；p=0.009）被确定为独立的阳性预测因素。闭塞段近端钝/无残端（OR：0.22；95% CI：0.06-0.64；p=0.009）、Stingray ADR 前的决策时间（每增加 1 小时）（OR：0.54；95% CI：0.31-0.92；p=0.026）、Stingray ADR 操作时间（每增加 10 分钟）（OR：0.62；95% CI：0.40-0.94；p=0.028）和经皮穿刺部位位于斑块内区域（OR：0.24；95% CI：0.06-0.84；p=0.026）被确定为四个独立的阴性预测因素。
本研究揭示了使用 Stingray ADR 技术进行 CTO PCI 成功的独立预测因素。就 CTO 特征而言，CTO 节段内存在钙化和病变部位近端的锥形残端有助于成功进行 Stingray ADR。就手术过程而言，通过果断和迅速地开始该技术、快速准确地操作系统以及在逆行引导下在 CTO 的远端帽区进行穿刺，可以提高 Stingray ADR 的成功率。
