Tadano Yutaka, Eka Putra Bayushi, Sugie Takuro, Kuramitsu Shoichi, Kaneko Umihiko, Kanno Daitaro, Fujita Tsutomu
Department of Cardiology, Sapporo Cardio Vascular Clinic, 8-1, North 49-East 16, Higashi ward, Sapporo, Hokkaido 007-0849, Japan.
Eur Heart J Case Rep. 2025 Jul 24;9(8):ytaf355. doi: 10.1093/ehjcr/ytaf355. eCollection 2025 Aug.
Since chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is mainly aimed at symptom relief, it should avoid placing patients at risk. Tip detection-antegrade dissection and re-entry (TD-ADR), whose wiring time has been reported to be shorter compared to retrograde approach, do not need a dual access. Although the retrograde approach is effective, it is a significant risk factor for in-hospital adverse events after CTO PCI. We are advocating 'Minimalistic Approach with Tip detection-antegrade dissection and re-entry' (MAT) which positions antegrade wiring as the first, tip-detection intravascular ultrasound-guided wiring as the second, and the retrograde approach as the third option.
This case series describes three PCIs performed via a single radial access for right coronary artery CTOs characterized by a puncturable proximal cap and non-diffuse calcification. It was possible for TD-ADR to stick to the CTO body and preserves side branches distal to the CTO.
MAT enables antegrade CTO treatment with a single radial access. While TD-ADR is difficult in diffusely calcified CTO, complications of TD-ADR are limited to those that can be adequately anticipated and managed, unlike those associated with the retrograde approach. MAT likely reduces procedural risks and improves patient comfort.
由于慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）主要旨在缓解症状，应避免使患者处于风险之中。与逆行途径相比，据报道其导丝通过时间较短的尖端探测-正向夹层分离和重新进入（TD-ADR）不需要双入路。尽管逆行途径有效，但它是CTO PCI后院内不良事件的一个重要风险因素。我们提倡“采用尖端探测-正向夹层分离和重新进入的简约方法”（MAT），该方法将正向导丝置入作为首选，尖端探测血管内超声引导下导丝置入作为次选，逆行途径作为第三选择。
本病例系列描述了通过单一桡动脉入路对右冠状动脉CTO进行的3例PCI，其特点为近端帽可穿刺且无弥漫性钙化。TD-ADR能够附着于CTO病变主体并保留CTO远端的侧支。
MAT能够通过单一桡动脉入路进行正向CTO治疗。虽然在弥漫性钙化的CTO中TD-ADR操作困难，但与逆行途径相关的并发症不同，TD-ADR的并发症仅限于那些能够充分预见和处理的并发症。MAT可能会降低手术风险并提高患者舒适度。
