Strepkos Dimitrios, Rempakos Athanasios, Alexandrou Michaella, Mutlu Deniz, Carvalho Pedro E P, Bahbah Ali, Kostantinis Spyridon, Choi James W, Gorgulu Sevket, Jaffer Farouc A, Chandwaney Raj, Alaswad Khaldoon, Basir Mir B, Azzalini Lorenzo, Ozdemir Ramazan, Uluganyan Mahmut, Khatri Jaikirshan, Young Laura, Poommipanit Paul, Aygul Nazif, Davies Rhian, Krestyaninov Oleg, Khelimskii Dmitrii, Goktekin Omer, Tuner Hasim, Rafeh Nidal Abi, Elguindy Ahmed, Rangan Bavana V, Mastrodemos Olga C, Voudris Konstantinos, Al-Ogaili Ahmed, Burke M Nicholas, Sandoval Yader, Brilakis Emmanouil S
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Yale New Haven Hospital, New Haven, Connecticut, USA.
Catheter Cardiovasc Interv. 2025 Jan;105(1):1-10. doi: 10.1002/ccd.31338. Epub 2024 Dec 11.
Proximal vessel tortuosity can hinder wiring and equipment delivery during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We sought to examine the association of proximal vessel tortuosity with the short and long-term outcomes of patients undergoing CTO PCI.
We examined the association of proximal vessel tortuosity with clinical outcomes in patients who underwent CTO PCI at 50 US and non-US centers between 2012 and 2024.
Of 14,141 patients, 3,974 (28.1%) had moderate or severe proximal vessel tortuosity. Patients with moderate or severe proximal vessel tortuosity had more comorbidities and more complex angiographic characteristics, such as longer lesion length and higher prevalence of side branch at the proximal cap. Lesions with moderate or severe proximal tortuosity required greater procedure and fluoroscopy time. On unadjusted analyses, moderate/severe proximal vessel tortuosity was associated with lower technical success and higher incidence of major adverse cardiac events (MACE). In multivariable analysis, moderate/severe proximal vessel tortuosity was associated with lower technical success (odds ratio [OR]: 0.77; 95% confidence intervals [CI]: 0.67, 0.89) but similar MACE (OR: 1.26; 95% CI: 0.91, 1.73). Higher operator volume (≥ 30 CTO PCI cases per year) was associated with higher technical (85.2% vs. 75.6%, p < 0.001) and procedural success (83.6% vs. 74.5%, p < 0.001) but also higher risk of perforation (6.49% vs. 3.57%, p < 0.001) but not pericardiocentesis, in lesions with moderate/severe proximal vessel tortuosity.
Moderate or severe proximal vessel tortuosity is independently associated with lower technical success in CTO PCI but not with MACE. High-volume operators are more likely to successfully perform CTO PCI in lesions with moderate/severe tortuosity at the cost of higher risk of perforation, without higher MACE.
在慢性完全闭塞性（CTO）经皮冠状动脉介入治疗（PCI）过程中，近端血管迂曲会阻碍导丝置入和器械输送。
我们试图研究近端血管迂曲与接受CTO PCI患者的短期和长期预后之间的关联。
我们研究了2012年至2024年间在美国和非美国的50个中心接受CTO PCI患者的近端血管迂曲与临床预后之间的关联。
在14141例患者中，3974例（28.1%）存在中度或重度近端血管迂曲。中度或重度近端血管迂曲的患者合并症更多，血管造影特征更复杂，如病变长度更长，近端帽处侧支发生率更高。中度或重度近端迂曲的病变需要更长的手术时间和透视时间。在未调整分析中，中度/重度近端血管迂曲与较低的技术成功率和较高的主要不良心脏事件（MACE）发生率相关。在多变量分析中，中度/重度近端血管迂曲与较低的技术成功率（优势比[OR]：0.77；95%置信区间[CI]：0.67，0.89）相关，但MACE相似（OR：1.26；95%CI：0.91，1.73）。较高的术者手术量（每年≥30例CTO PCI病例）与较高的技术成功率（85.2%对75.6%，p<0.001）和手术成功率（83.6%对74.5%，p<0.001）相关，但在中度/重度近端血管迂曲的病变中穿孔风险也较高（6.49%对3.57%，p<0.001），但心包穿刺风险无差异。
中度或重度近端血管迂曲与CTO PCI中较低的技术成功率独立相关，但与MACE无关。高手术量的术者更有可能在中度/重度迂曲病变中成功进行CTO PCI，代价是穿孔风险较高，但MACE无增加。
