CTO介入中使用新型穿刺导丝进行尖端检测、顺行夹层分离和再入：通过三维布线实现的革命
Tip Detection-Antegrade Dissection and Re-Entry With New Puncture Wire in CTO Intervention: Revolution Through 3D-Wiring.
作者信息
Tanaka Kota, Okamura Atsunori, Yoshikawa Ryouhei, Tsuchikane Etsuo, Ishikawa Masato, Suzuki Satoshi, Nagai Hiroyuki, Sumiyoshi Akinori, Kawahira Masatsugu, Yamasaki Tomohiro, Matsuda Hiroaki, Iwamoto Mutsumi, Watanabe Satoshi, Yamasaki Keita, Tanaka Nobuaki, Koyama Yasushi, Iwanaga Yoshitaka, Watanabe Heitaro
机构信息
Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
Sanda City Hospital, Sanda, Japan.
出版信息
JACC Asia. 2024 Feb 27;4(5):359-372. doi: 10.1016/j.jacasi.2023.11.017. eCollection 2024 May.
BACKGROUND
The authors devised the tip detection (TD) method and developed AnteOwl WR intravascular ultrasound to standardize intravascular ultrasound-based 3-dimensional wiring for intraplaque tracking in chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). The TD method also allowed antegrade dissection and re-entry (ADR). Combining TD-ADR with Conquest Pro 12 Sharpened Tip (CP12ST) wire, a new ADR wire with the strongest penetration force developed to date, enabled re-entry anywhere except calcification sites.
OBJECTIVES
This study investigated the efficacy and feasibility of TD-ADR by comparison of procedural outcomes with Stingray-ADR in CTO-PCI.
METHODS
Twenty-seven consecutive CTO cases treated by TD-ADR with CP12ST wire between August 2021 and April 2023 and 27 consecutive CTO cases treated by Stingray-ADR with Conquest 8-20 (CP20) wire between March 2018 and July 2021 were retrospectively enrolled as the TD-ADR by CP12ST wire group and Stingray-ADR by CP20 wire group, respectively, from 4 facilities that could share technical information on these procedures.
RESULTS
The success rate of the ADR procedure was significantly improved (27 of 27 cases [100%] vs 18 of 27 cases [67%], respectively; = 0.002) and total procedural time was significantly reduced (median procedural time: 145.0 [Q1-Q3: 118.0-240.0] minutes vs 185.0 [Q1-Q3: 159.5-248.0] minutes, respectively; = 0.028) in the TD-ADR by CP12ST wire group compared to the Stingray-ADR by CP20 wire group. There were few in-hospital major adverse cardiac and cerebrovascular events or no complications in either group.
CONCLUSIONS
TD-ADR by CP12ST wire can standardize highly accurate ADR in CTO-PCI.
背景
作者设计了尖端检测（TD）方法，并开发了AnteOwl WR血管内超声，以标准化基于血管内超声的三维布线，用于慢性完全闭塞（CTO）-经皮冠状动脉介入治疗（PCI）中的斑块内追踪。TD方法还允许顺行夹层和重新进入（ADR）。将TD-ADR与Conquest Pro 12锐尖（CP12ST）导丝相结合，这是一种迄今开发的穿透力最强的新型ADR导丝，能够在除钙化部位以外的任何地方重新进入。
目的
本研究通过比较CTO-PCI中TD-ADR与Stingray-ADR的手术结果，探讨TD-ADR的有效性和可行性。
方法
回顾性纳入2021年8月至2023年4月期间连续27例采用CP12ST导丝进行TD-ADR治疗的CTO病例，以及2018年3月至2021年7月期间连续27例采用Conquest 8-20（CP20）导丝进行Stingray-ADR治疗的CTO病例，分别作为CP12ST导丝TD-ADR组和CP20导丝Stingray-ADR组，来自4个能够共享这些手术技术信息的机构。
结果
与CP20导丝Stingray-ADR组相比，CP12ST导丝TD-ADR组的ADR手术成功率显著提高（分别为27例中的27例[100%]和27例中的18例[67%]；P = 0.002），总手术时间显著缩短（中位手术时间：分别为145.0[第一四分位数-第三四分位数：118.0-240.0]分钟和185.0[第一四分位数-第三四分位数：159.5-248.0]分钟；P = 0.028）。两组院内主要不良心脑血管事件均较少或无并发症。
结论
CP12ST导丝TD-ADR可在CTO-PCI中标准化高度准确的ADR。
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