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慢性完全闭塞性经皮冠状动脉介入治疗的解剖与再入技术

Dissection and Re-entry Techniques for Chronic Total Occlusion Percutaneous Coronary Intervention.

作者信息

Masoomi Reza, Boukhris Marouane, Moscardelli Silvia, Azzalini Lorenzo

机构信息

Division of Cardiology, University of Washington Seattle, WA, US.

Division of Cardiology, CHU Dupuytren Limoges, France.

出版信息

Interv Cardiol. 2024 Sep 4;19:e16. doi: 10.15420/icr.2024.04. eCollection 2024.

DOI:10.15420/icr.2024.04
PMID:39309300
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11413985/
Abstract

Despite early stagnation in success rates for percutaneous coronary intervention for chronic total occlusion with the traditional antegrade wiring approach, the introduction of dissection/re-entry techniques and the retrograde approach opened new avenues for operators to tackle more complex occlusions. Dissection/re-entry techniques (both antegrade and retrograde) are commonly used in angiographic scenarios characterised by long, tortuous and calcified occlusions, as well as in those with proximal cap ambiguity. Familiarity and comfort using the extraplaque space (with either an antegrade or retrograde approach) have become fundamental to achieving safe and effective recanalisation of complex chronic total occlusions. This review provides an overview of different contemporary antegrade and retrograde dissection re-entry techniques and their acute and longer-term outcomes.

摘要

尽管采用传统顺行导丝技术进行经皮冠状动脉介入治疗慢性完全闭塞病变的成功率在早期停滞不前，但夹层/重新进入技术和逆行技术的引入为术者处理更复杂的闭塞病变开辟了新途径。夹层/重新进入技术（顺行和逆行）常用于具有长段、迂曲和钙化闭塞特点的血管造影情况，以及近端帽模糊不清的情况。熟悉并能自如运用斑块外间隙（顺行或逆行方法）已成为实现复杂慢性完全闭塞病变安全有效再通的关键。本综述概述了当代不同的顺行和逆行夹层重新进入技术及其急性和长期结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/be336f389fc6/icr-19-e16-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/8520cb7603bc/icr-19-e16-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/9242396b27e2/icr-19-e16-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/be336f389fc6/icr-19-e16-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/8520cb7603bc/icr-19-e16-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/9242396b27e2/icr-19-e16-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/715f/11413985/be336f389fc6/icr-19-e16-g003.jpg

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本文引用的文献

1
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Prog Cardiovasc Dis. 2025 Jan-Feb;88:20-27. doi: 10.1016/j.pcad.2024.07.001. Epub 2024 Jul 18.
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Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions.经皮腔内血管成形术联合正向和逆向内膜下寻径技术治疗慢性完全闭塞病变。
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Intravascular Lithotripsy-Facilitated Balloon-Assisted Subintimal Entry for Chronic Total Occlusion Percutaneous Coronary Intervention.
血管内碎石术辅助球囊引导的内膜下穿刺用于慢性完全闭塞性经皮冠状动脉介入治疗
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Clinical Experience of a Novel Optical Coherence Tomography-Guided Coronary Chronic Total Occlusion Re-Entry Device.一种新型光学相干断层扫描引导的冠状动脉慢性完全闭塞再入路装置的临床经验
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The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes.逆行技术在慢性完全闭塞病变经皮冠状动脉介入治疗中的应用：技术分析与临床结果。
JACC Cardiovasc Interv. 2023 Nov 27;16(22):2748-2762. doi: 10.1016/j.jcin.2023.08.031.
6
STAR procedure becomes SAFER: First-in-man case series of a new antegrade dissection re-entry technique.STAR手术更安全：首例人体新型顺行剥离再入技术病例系列
Catheter Cardiovasc Interv. 2023 Oct;102(4):577-584. doi: 10.1002/ccd.30789. Epub 2023 Jul 31.
7
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JACC Cardiovasc Interv. 2023 Jun 26;16(12):1546-1548. doi: 10.1016/j.jcin.2023.04.019.
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EuroIntervention. 2023 Apr 3;18(16):e1388-e1389. doi: 10.4244/EIJ-D-22-00838.
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