Kashiyama Toshikazu, Okamura Atsunori, Koyama Yasushi, Iwamoto Mustumi, Watanabe Satoshi, Sumiyoshi Akinori, Tanaka Kota, Watanabe Heitaro, Sakata Yasushi, Iwakura Katsuomi
Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital, 4-3-51 Nakanoshima, Kita Ward, Osaka, 530-0005, Japan.
Department of Cardiology, Sumitomo Hospital, Osaka, Japan.
Cardiovasc Interv Ther. 2025 Jan;40(1):68-78. doi: 10.1007/s12928-024-01061-x. Epub 2024 Oct 25.
The tip-detection method and the retrograde approach have been acknowledged as a second-line strategies for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) when conventional antegrade wiring strategies are ineffective. The aim of this study is to compare the efficacy between both strategies for complex CTO PCI.
We retrospectively enrolled 170 consecutive CTO PCI cases and separated them into 295 adopted strategies. The rate of successful lesion crossing and its association with the time spent for each strategy were compared between the tip-detection method and the retrograde approach.
We observed fifty-six attempts with the tip-detection methods with 46 (82.1%) successful lesion crossings. Sixty-one retrograde approaches were performed, in which 29 (47.5%) cases achieved procedural success. In the successful attempts, the wire-manipulation time was significantly shorter in the tip-detection method [20.0 (12.2-36.7) min] than the retrograde approach [35.0 (20.7-49.7) min] (p = 0.008). Cox-regression analysis showed time-dependent advantage for the tip-detection method over the retrograde approach [hazard ratio (HR) = 2.93, 95% CI = 1.84-4.67, p < 0.001]. Incomplete tip-detection CTO crossing (taking > 30 min) was seen in severely tortuous lesions [odds ratio 0.26, 95% confidence interval 0.06-0.97, p = 0.037].
The tip-detection method can reduce the wire-manipulation time for successful CTO PCI compared with the retrograde approach. However, the success rate of the tip-detection method is hampered by severe lesion tortuosity.
当传统的顺行导丝策略无效时，尖端探测法和逆行路径已被公认为慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的二线策略。本研究的目的是比较这两种策略在复杂CTO PCI中的疗效。
我们回顾性纳入了170例连续的CTO PCI病例，并将其分为295种采用的策略。比较了尖端探测法和逆行路径之间成功病变通过的比率及其与每种策略所花费时间的关联。
我们观察到56次使用尖端探测法的尝试，其中46次（82.1%）成功通过病变。进行了61次逆行路径操作，其中29例（47.5%）获得手术成功。在成功的尝试中，尖端探测法的导丝操作时间[20.0（12.2 - 36.7）分钟]明显短于逆行路径[35.0（20.7 - 49.7）分钟]（p = 0.008）。Cox回归分析显示，尖端探测法相对于逆行路径具有时间依赖性优势[风险比（HR）= 2.93，95%置信区间 = 1.84 - 4.67，p < 0.001]。在严重迂曲的病变中可见不完全的尖端探测CTO通过（耗时> 30分钟）[优势比0.26，95%置信区间0.06 - 0.97，p = 0.037]。
与逆行路径相比，尖端探测法可减少成功CTO PCI的导丝操作时间。然而，严重的病变迂曲会阻碍尖端探测法的成功率。
