Cardiovascular Division, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
Cardiovascular Division, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Ann Med. 2024 Dec;56(1):2396076. doi: 10.1080/07853890.2024.2396076. Epub 2024 Aug 28.
As the burden and distribution of calcification within chronic total occlusion (CTO) lesions can be diverse, its effect on CTO recanalization using multiple devices and techniques is debatable. This study investigated the role of calcification in wiring-based intraplaque tracking techniques for CTO recanalization.
A modified J-CTO score without counting calcification was used to analyze the procedures of 458 consecutive patients who underwent CTO interventions. Failed guidewire crossing and intraplaque tracking were considered procedural failures. Recanalization time details were analyzed for successful procedures.
In patients with calcified CTO, the rate of procedural success only significantly declined to be lower than that of noncalcified CTO when the modified J-CTO score was ≥3 (77% vs. 94%, = 0.008). In 422 patients with successful procedures, the presence of calcification was irrelevant to guidewire crossing time, but was accompanied with longer time from guidewire cross to final angiogram when the modified J-CTO score was 1-2 (53 ± 35 vs. 35 ± 17 [noncalcified] min, < 0.001). Multivariate analyses showed that calcification was independently associated with procedural failure (odds ratio [OR] = 5.1, 95% confidence interval [CI] = 1.4-18.3) in lesions with modified J-CTO ≥3, and prolonged angioplasty/stenting procedures >60 min (OR = 4.8, 95% CI = 2.2-10.2) in successfully recanalized lesions with modified J-CTO score 1-2.
Using intraplaque guidewire tracking, calcification was unfavorable for very difficult CTO lesions, and caused prolongation of angioplasty time for lesions with moderate complexity. This suggested that the role of calcification in the J-CTO score could be altered when different recanalization techniques were applied for CTO interventions.
由于慢性完全闭塞（CTO）病变内的钙化负担和分布可能多种多样，因此使用多种设备和技术进行 CTO 再通的效果存在争议。本研究探讨了钙化在基于导丝的斑块内跟踪技术治疗 CTO 再通中的作用。
使用改良的 J-CTO 评分（不计钙化）分析 458 例连续接受 CTO 介入治疗的患者的手术过程。导丝无法通过和斑块内跟踪被视为手术失败。对成功手术的再通时间细节进行分析。
在钙化性 CTO 患者中，当改良 J-CTO 评分≥3 时，手术成功率仅显著下降至低于非钙化性 CTO（77%比 94%， = 0.008）。在 422 例成功手术的患者中，当改良 J-CTO 评分为 1-2 时，钙化的存在与导丝通过时间无关，但与导丝通过至最终血管造影时间较长相关（53 ± 35 比 35 ± 17 [非钙化性] min， < 0.001）。多变量分析显示，在改良 J-CTO≥3 的病变中，钙化与手术失败独立相关（比值比[OR] = 5.1，95%置信区间[CI] = 1.4-18.3），在改良 J-CTO 评分 1-2 的成功再通病变中，血管成形术/支架置入术时间延长>60 min（OR=4.8，95% CI=2.2-10.2）。
使用斑块内导丝跟踪技术时，钙化不利于非常困难的 CTO 病变，而对于中等复杂程度的病变则会延长血管成形术时间。这表明在应用不同的再通技术治疗 CTO 时，J-CTO 评分中钙化的作用可能会发生改变。
