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冠状动脉慢性完全闭塞病变介入治疗临床疗效分析

Clinical efficacy of percutaneous coronary intervention for patients with coronary chronic total occlusion

  • 摘要: 目的:探讨国人冠状动脉慢性完全闭塞病变(CTO)患者的介入治疗特点及影响因素。方法:入选2017年中国冠状动脉慢性闭塞病变俱乐部(CTOCC)的CTO患者40例,分析介入治疗过程的特点以及操作成功率。结果:40例患者闭塞时间为3~56个月,均为首次介入治疗失败者,J-CTO 评分均≥3分,术前均行冠状动脉CT检查,双侧造影使用率为100%。通过前向技术成功开通血管23例,血管内超声(IVUS)指导下正向钢丝技术及平行导引钢丝技术为术者最常采用的正向技术,其中5例患者采用正向内膜下重回真腔(antegrade dissection reentry,ADR) 技术4例获得成功;逆向导丝通过法成功完成介入治疗14例,使用Reverse CART技术10例。术中使用平均钢丝数为5.07根,术者最常用软导丝是Sion系列钢丝35例( 82.5%),其次为Runthrough钢丝22例(55%),再次为锥形导丝Fielder系列钢丝15例(37.5%),成功通过病变5例(12.5%)。使用硬导引钢丝通过病变32例(80%),通过CTO 病变术者最常使用的硬导引钢丝为Gaia系列钢丝23例( 57.5%),其次为Conquest系列导引钢丝19例(47.5%),再者为Pilot系列钢丝18例(45.0%)。术中微导管使用率为100%,其中Cosair导管最常使用(33例,82.5%)。操作中IVUS使用22例(55%),主要用于判断导丝远端是否位于真腔、植入支架时管腔直径判断及寻找闭塞血管入口。40例患者平均球囊使用3.24个,平均植入支架2.53个,均为药物洗脱支架,PCI成功37例,未成功3例,PCI成功率达92.5%。住院期间无主要心血管不良事件发生。结论:2017年CTOCC病例介入治疗成功率高于目前国内外CTO介入治疗的平均成功率;这得益于术者经验丰富、术前充分阅片、冠脉CT使用率高、术中IVUS充分使用以及合理的使用导丝、器械及合理的策略选择。

     

    Abstract: Objective:To investigate the characteristics and influencing factors of percutaneous coronary intervention (PCI) in Chinese patients with coronary chronic total occlusion (CTO). Methods:Forty patients from the Chronic Total Occlusions Club, China (CTOCC) in 2017 were enrolled, the characteristics of interventional treatment process and the success rate of operation were analyzed. Results:Mean occlusion duration of the 40 patients was 3-56 months, and the mean J-CTO score ≥3. All patients underwent coronary CT examination before PCI. Bilateral angiography was used in all cases. Overall success recanalization rate was 92.5% (37/40). Twenty-three patients were successfully recanalized through antgrade approach (23/40, 57.5%). Retrograde approach as the primary strategy was applied in 14/40 (35%) patients. The most commonly used soft guidewire Sion was used in 82.5% (35/40) of patients, the usage of Runthrough (22/40, 55%) ranked next, and the third was Fielder (15/40, 37.5%). Stiff wires were commonly used during the operation (32/40, 80%), among which Gaia (57.5%), Conquest (47.5%), and Pilot (45%) series of guide wires were used most frequently. The parallel wire technique was mostly applied when the first guide wire failed to cross the lesion. Micro-catheter was used in all cases and Cosair catheter was used most frequently. The intravascular ultrasound (IVUS) was used in 55% of the cases. There were no in-hospital major adverse cardiac events during the follow-up. Conclusions:The success rate of CTOCC cases in 2017 is higher than that of the average success rate of CTO cases reported at home and abroad. This might be due to the experienced operators, full preoperative film reading, high utilization rate of coronary CT, full use of IVUS during operation, reasonable use of guide wires, instruments, and reasonable strategic choices.

     

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