Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was c...Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CT展开更多
Although retrograde approach has greatly improved the success rate of percutaneous coronary intervention(PCI) for coronary chronic total occlusion(CTO), retrograde wire externalization still remains challenging and ti...Although retrograde approach has greatly improved the success rate of percutaneous coronary intervention(PCI) for coronary chronic total occlusion(CTO), retrograde wire externalization still remains challenging and time-consuming in some cases. Cases utilizing ‘‘Active Greeting Technique(AGT)", a mother-and-child catheter based technique to facilitate retrograde wire externalization, were extracted from Chronic Total Occlusion Club, China(CTOCC) database. AGT was performed by deep intubation a mother-and-child catheter(GuidezillaTMextension, 4 or 5 Fr inner catheter, and etc.) in combination with either reverse controlled antegrade or retrograde subintimal tracking(CART) technique or retrograde wire crossing technique. A total of 111 patients with 112 CTO lesions treated with this technique were retrospectively analyzed. Reverse CART technique and retrograde wire crossing technique were performed in 90.2% and 9.8% of all procedures. The utilization of GuidezillaTMextension, 4 Fr, and 5 Fr inner catheter accounted for 94.6%, 3.6%, and 1.8%, respectively. Externalization of retrograde wire was successful in all cases. No procedural complications were adjudicated to AGT. Complications independent of AGT included two target vessel perforations and two collateral perforations. No in-hospital major adverse cardiac events were found. AGT is a feasible and safe technique that facilitates retrograde wire externalization.展开更多
Background The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion （CTO） lesions during percutaneous recanalization of coronary arteries. This study was to investigat...Background The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion （CTO） lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach. Methods Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated. Results Mean age of the patient was （59.6＋11.2） years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases （53.5%）, left circumflex artery in one case （1.2%）, right coronary artery in 34 cases （40.5%）, and left main in four cases （4.8%）. The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 （81%） vs. 16/84 （19%）. Successful wire passage through the collateral channel was achieved in 58 （72.6%） patients. The success rate of recanalization was 93.1% （54/58） in patients with and 50% （13/26） in patients without successful retrograde wire passage of the collateral channel （P 〈0.01）. Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals （72.1%） and in 9 of 16 epicardial collaterals （56.3%） （P=NS）. There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals （91.8% vs. 100%, P 〉0.05）. CART or reverse CART technique was used in 15 patients, and 14 patients （93.3%） were recanalized successfully. Collateral related perforation occurred in three （18.8%） cases with the epicardial collateral as the first choice （compared with the septal collateral group 展开更多
目的探讨入院纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio, FAR)预测冠状动脉慢性完全闭塞病变(chronic total occlusion, CTO)侧支循环形成及预后的价值。方法选取2017年10月-2019年4月在郑州大学第二附属医院择期行经皮冠状...目的探讨入院纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio, FAR)预测冠状动脉慢性完全闭塞病变(chronic total occlusion, CTO)侧支循环形成及预后的价值。方法选取2017年10月-2019年4月在郑州大学第二附属医院择期行经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术且至少1支主要冠状动脉CTO的冠心病患者126例。依据Cohen-Rentrop法将CTO患者分为侧支循环不良组(72例)和良好组(54例)。应用多因素logistic回归筛选评价CTO患者侧支循环形成的影响因素,采用受试者工作特征(receiver operating characteristic, ROC)曲线评价FAR预测CTO患者侧支循环形成的价值,以随访1年内主要不良心血管事件(major adverse cardiovascular events, MACE)发生率评价患者预后。结果侧支循环良好组患者FAR和高敏C反应蛋白水平均低于不良组(均P<0.001)。多因素logistic回归分析显示,FAR、高敏C反应蛋白与CTO患者侧支循环形成良好呈独立负相关。ROC曲线显示,入院FAR水平预测CTO患者侧支循环形成良好的曲线下面积为0.832(95%CI:0.755~0.893,P<0.001),诊断临界值为9.62,敏感度为85.19%,特异度为77.78%。结论入院FAR水平对CTO患者侧支循环形成良好有一定的预测价值。较低FAR患者侧支循环形成更好,MACE事件发生率低,预后越好。展开更多
目的评价管腔扩张导管(Corsair微导管)联合新型慢性闭塞病变专用导丝在冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变介入治疗中的有效性与安全性。方法选择2011年12月至2013年8月应用Corsair微导管联合新型CTO病变专用导丝处...目的评价管腔扩张导管(Corsair微导管)联合新型慢性闭塞病变专用导丝在冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变介入治疗中的有效性与安全性。方法选择2011年12月至2013年8月应用Corsair微导管联合新型CTO病变专用导丝处理CTO病变的89例患者为Corsair微导管组(A组),以Corsair微导管应用前的89例CTO病变患者为对照组(B组),记录两组患者的临床特征、冠状动脉造影所见病变特点、介入操作成功率和并发症发生率,随访术后主要不良心脏事件的发生率。结果 Corsair微导管组患者病变成功完成支架置入81例,操作成功率为91.0%,而对照组操作成功62例,操作成功率为69.7%,两组比较差异有统计学意义(P<0.05)。Corsair微导管组造影时间及操作时间、对比剂用量均较对照组减少,术中术后无严重并发症,无死亡。结论 Corsair微导管联合新型CTO病变专用导丝用于经皮冠状动脉介入治疗CTO病变可以提高介入操作成功率。展开更多
文摘Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CT
基金国家十二五科技支撑计划课题，国家新药创制(创新药物研究开发技术平台建设)(2012ZX09303016-002)This work was supported by the Supporting Program of the 'Twelfth Five-year Plan' for Sci & Tech Research of China，State Project For New Drug Research and Development
基金funded by National Key R&D Program of China (2016YFC1301200)
文摘Although retrograde approach has greatly improved the success rate of percutaneous coronary intervention(PCI) for coronary chronic total occlusion(CTO), retrograde wire externalization still remains challenging and time-consuming in some cases. Cases utilizing ‘‘Active Greeting Technique(AGT)", a mother-and-child catheter based technique to facilitate retrograde wire externalization, were extracted from Chronic Total Occlusion Club, China(CTOCC) database. AGT was performed by deep intubation a mother-and-child catheter(GuidezillaTMextension, 4 or 5 Fr inner catheter, and etc.) in combination with either reverse controlled antegrade or retrograde subintimal tracking(CART) technique or retrograde wire crossing technique. A total of 111 patients with 112 CTO lesions treated with this technique were retrospectively analyzed. Reverse CART technique and retrograde wire crossing technique were performed in 90.2% and 9.8% of all procedures. The utilization of GuidezillaTMextension, 4 Fr, and 5 Fr inner catheter accounted for 94.6%, 3.6%, and 1.8%, respectively. Externalization of retrograde wire was successful in all cases. No procedural complications were adjudicated to AGT. Complications independent of AGT included two target vessel perforations and two collateral perforations. No in-hospital major adverse cardiac events were found. AGT is a feasible and safe technique that facilitates retrograde wire externalization.
基金This study was supported by a grant from National Natural Science Foundation of China （No. 30901383）.
文摘Background The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion （CTO） lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach. Methods Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated. Results Mean age of the patient was （59.6＋11.2） years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases （53.5%）, left circumflex artery in one case （1.2%）, right coronary artery in 34 cases （40.5%）, and left main in four cases （4.8%）. The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 （81%） vs. 16/84 （19%）. Successful wire passage through the collateral channel was achieved in 58 （72.6%） patients. The success rate of recanalization was 93.1% （54/58） in patients with and 50% （13/26） in patients without successful retrograde wire passage of the collateral channel （P 〈0.01）. Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals （72.1%） and in 9 of 16 epicardial collaterals （56.3%） （P=NS）. There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals （91.8% vs. 100%, P 〉0.05）. CART or reverse CART technique was used in 15 patients, and 14 patients （93.3%） were recanalized successfully. Collateral related perforation occurred in three （18.8%） cases with the epicardial collateral as the first choice （compared with the septal collateral group
文摘目的评价管腔扩张导管(Corsair微导管)联合新型慢性闭塞病变专用导丝在冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变介入治疗中的有效性与安全性。方法选择2011年12月至2013年8月应用Corsair微导管联合新型CTO病变专用导丝处理CTO病变的89例患者为Corsair微导管组(A组),以Corsair微导管应用前的89例CTO病变患者为对照组(B组),记录两组患者的临床特征、冠状动脉造影所见病变特点、介入操作成功率和并发症发生率,随访术后主要不良心脏事件的发生率。结果 Corsair微导管组患者病变成功完成支架置入81例,操作成功率为91.0%,而对照组操作成功62例,操作成功率为69.7%,两组比较差异有统计学意义(P<0.05)。Corsair微导管组造影时间及操作时间、对比剂用量均较对照组减少,术中术后无严重并发症,无死亡。结论 Corsair微导管联合新型CTO病变专用导丝用于经皮冠状动脉介入治疗CTO病变可以提高介入操作成功率。
