慢性完全闭塞性经皮冠状动脉介入治疗中传统与双腔微导管辅助平行导丝技术的比较：来自PROGRESS-CTO注册研究的见解
Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.
作者信息
Mutlu Deniz, Strepkos Dimitrios, Ser Ozgur Selim, Carvalho Pedro E P, Alexandrou Michaella, Jalli Sandeep, Azzalini Lorenzo, Ybarra Luiz, Alaswad Khaldoon, Jaffer Farouc A, Davies Rhian, Rangan Bavana V, Sandoval Yader, Nicholas Burke M, Gorgulu Sevket, Brilakis Emmanouil S
机构信息
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
University of Washington, Seattle, Washington, USA.
出版信息
Catheter Cardiovasc Interv. 2025 May;105(6):1493-1501. doi: 10.1002/ccd.31472. Epub 2025 Mar 10.
BACKGROUND
The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
AIMS
To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.
METHODS
We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.
RESULTS
Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator's discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p < 0.001). Technical (87.1% vs. 74.3%, p < 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89-4.50, p = 0.093).
CONCLUSIONS
In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring.
背景
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，传统单腔微导管与双腔微导管（DLMC）辅助平行导丝技术的有效性和安全性研究有限。
目的
比较传统单腔微导管与双腔微导管（DLMC）辅助平行导丝技术。
方法
在一个大型多中心CTO PCI注册研究中，我们比较了正向导丝技术（AW）失败后传统单腔微导管与DLMC辅助平行导丝技术的临床、血管造影特征及结果。
结果
在1353例单根导丝AW失败的CTO PCI中，术者可自行选择使用传统平行导丝技术（n = 1081）或DLMC辅助平行导丝技术（n = 272）。两组患者的基线特征相似，但DLMC组糖尿病患病率较高，而高血压、既往心力衰竭、既往心肌梗死和脑血管疾病的患病率较低。DLMC组病变更易出现近端帽模糊、近端帽处有侧支、钝圆/无残端、中度/重度钙化，且J-CTO评分更高（2.6±1.0对2.1±1.3，p < 0.001）。DLMC组技术成功率（87.1%对74.3%，p < 0.001）、手术成功率（83.8%对75.5%，p = 0.001）及院内主要心脏不良事件（MACE）发生率（4.8%对2.0%，p = 0.020）更高。在倾向评分匹配分析中，DLMC辅助导丝技术与更高的技术成功率相关（优势比[OR] 2.17，95%置信区间[CI] 1.33 - 3.54，p = 0.002），且MACE无显著差异（OR 2.00，95% CI 0.89 - 4.50，p = 0.093）。
结论
在AW无法通过的病变中，与传统平行导丝技术相比，DLMC辅助平行导丝技术技术成功率更高，且MACE风险未增加。
Zotero 插件