Background Failure of balloon catheter passing through the occluded segment accounts for 10%-15% of all procedures during percutaneous coronary intervention （PCI） for chronic total occlusion （CTO）. We sought to in...Background Failure of balloon catheter passing through the occluded segment accounts for 10%-15% of all procedures during percutaneous coronary intervention （PCI） for chronic total occlusion （CTO）. We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing. Methods Between July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing. Results Both overall lesion and technique success rates were 91.5% （150/164）. A total of 211 crushing wires were used during. PCI, including 1 crushing wire for 117 （71.3%） lesions and 2 crushing wires for 47 （28.7%） lesions. Approximately 57.3% （121/211） of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions （8.5%）. Technique failure was due to crushing wires entering false lumen （92.9%, 13/14） and coronary perforation （7.1%, 1/14）. Major procedural complications included coronary perforation （1 case） and severe coronary dissection （2 cases）, all of which were successfully treated. Conclusions Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.展开更多
Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evalu...Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.展开更多
Background The success rate of antegrade approach for chronic total occlusions （CTO） recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. ...Background The success rate of antegrade approach for chronic total occlusions （CTO） recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility. Methods We identified 42 patients who underwent revascularization in CTO with retrograde approach from July 2005 to November 2009 in our center.Results Three kinds of strategy were applied： retrograde as primary strategy （50.0%）, retrograde immediately after antegrade failure （26.2%） and repeat procedure after previous antegrade failure （23.8%）. Septal collaterals were more frequently used as the retrograde access route （92.9%）. Overall success rate was 88.1%. In patients with successful retrograde wire crossing collateral channel to the distal cap of CTO, the success rate of recanalization was 94.1%. In patient with failure to cross the collaterals, the success rate was 62.5%. Eight different kinds of retrograde techniques were used： kissing wire technique （35.3%）, wire trapped and reverse wire trapped technique （17.6%）, back-end balloon and microcatherer reversal technique （14.7%）, controlled antegrade and retrograde subintimal tracking （CART） technique （8.8%）, reverse CART and modified reverse CART technique （8.8%）, retrograde wire crossing technique （2.9%）. There were 4 complications occurred without in-hospital major adverse cardiac events （MACE）. In-hospital MACE was 7.7%. All of them were non-Q wave myocardial infarction. There were no cases of death or target vessel revascularization, either surgery or percutaneous.Conclusions The retrograde approach can be an effective tool for increasing the success rate of recanalization in the very complex CTO. To ensure the success and safety of the approach, careful case selection and device handling by experienced operators is essential.展开更多
Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2...Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2009, 195 （41.1%） patients with 254 （47.0%） bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal （n=134） and distal （n=-120） groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization （TVR）. Results Collaterals with Rentrop class 3 were seen more in distal group （100% and 68.3%）, compared to proximal group （76.9% and 45.6%）. Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group （6.7%, P 〈0.001）, without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group （P=0.044）. Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization （HR 2.028, P=0.049, 95% CI 1.002-4.105） and post-stenting TIMI flow （HR 6.122, P=0.020, 95% Cl 1.334-28.092） were two independent predictors of composite MACE at the 1-year follow-up. Conclusions Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcom展开更多
经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是治疗冠状动脉粥样硬化性心脏病(冠心病)的常用方法。冠状动脉慢性完全闭塞(chronic total occlusion,CTO)是PCI最具挑战的病变之一,且术后并发症发生率较高[1]。PCI过...经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是治疗冠状动脉粥样硬化性心脏病(冠心病)的常用方法。冠状动脉慢性完全闭塞(chronic total occlusion,CTO)是PCI最具挑战的病变之一,且术后并发症发生率较高[1]。PCI过程中导丝嵌顿属于罕见并发症,与冠状动脉病变复杂性和医师操作等有关,处理不当可致嵌顿的导丝发生断裂。展开更多
目的:观察慢性完全闭塞病变(chronic total occlusion,CTO)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)成功对2年生存率的影响。方法:连续入选2005年1月～2010年9月在我院心内科住院共700例稳定型心绞痛患者,其...目的:观察慢性完全闭塞病变(chronic total occlusion,CTO)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)成功对2年生存率的影响。方法:连续入选2005年1月～2010年9月在我院心内科住院共700例稳定型心绞痛患者,其中84例(12%)为CTO患者。按照CTO病变成功开通组(开通组)或未成功开通组(未开通组)分层观察患者2年生存率。住院期间主要不良心脏事件(MACE)发生率,MACE包括心肌梗死、紧急血运重建、卒中或死亡。结果:未开通组先前进行血运重建治疗的患者比例显著大于开通组(PCI分别为36%vs.21%,P<0.01),两组的其他基线特征相似。术中并发症(包括冠状动脉夹层)在未开通组患者中更常见(分别为30.8%vs.10.3%;P<0.05),但没有影响院内MACE事件发生率(分别为3%和2%,P>0.05)。开通组2年生存率显著高于未开通组(96%vs.83%,P<0.01)。多因素分析显示手术成功为死亡概率的独立预测因子(HR:0.32,95%CI:0.18-0.58,P<0.01)。结论:CTO病变PCI术后开通组的2年生存率较未开通组显著提高。展开更多
Although the retrograde approach was a promising strategy for chronic total occlusions(CTO)-percutaneous coronary interventions(PCI),[1]with the development of coronary interventional therapy technology and interventi...Although the retrograde approach was a promising strategy for chronic total occlusions(CTO)-percutaneous coronary interventions(PCI),[1]with the development of coronary interventional therapy technology and interventional instruments,antegrade dissection and re-entry(ADR)are commonly employed in PCI to open CTO of coronary arteries.展开更多
慢性完全闭塞性病变(chronic total occlusions,CTO)在行冠状动脉造影的患者中非常普遍。观察性的研究显示,成功开通CTO可以改善患者生活质量,提升心血管病患者临床预后。但由于缺乏随机试验,其临床获益仍然存在争论。最新的欧洲心脏病...慢性完全闭塞性病变(chronic total occlusions,CTO)在行冠状动脉造影的患者中非常普遍。观察性的研究显示,成功开通CTO可以改善患者生活质量,提升心血管病患者临床预后。但由于缺乏随机试验,其临床获益仍然存在争论。最新的欧洲心脏病协会指南仍然将CTO患者行PCI治疗推荐为Ⅱa类(B级证据)。展开更多
文摘Background Failure of balloon catheter passing through the occluded segment accounts for 10%-15% of all procedures during percutaneous coronary intervention （PCI） for chronic total occlusion （CTO）. We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing. Methods Between July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing. Results Both overall lesion and technique success rates were 91.5% （150/164）. A total of 211 crushing wires were used during. PCI, including 1 crushing wire for 117 （71.3%） lesions and 2 crushing wires for 47 （28.7%） lesions. Approximately 57.3% （121/211） of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions （8.5%）. Technique failure was due to crushing wires entering false lumen （92.9%, 13/14） and coronary perforation （7.1%, 1/14）. Major procedural complications included coronary perforation （1 case） and severe coronary dissection （2 cases）, all of which were successfully treated. Conclusions Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.
文摘Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.
文摘Background The success rate of antegrade approach for chronic total occlusions （CTO） recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility. Methods We identified 42 patients who underwent revascularization in CTO with retrograde approach from July 2005 to November 2009 in our center.Results Three kinds of strategy were applied： retrograde as primary strategy （50.0%）, retrograde immediately after antegrade failure （26.2%） and repeat procedure after previous antegrade failure （23.8%）. Septal collaterals were more frequently used as the retrograde access route （92.9%）. Overall success rate was 88.1%. In patients with successful retrograde wire crossing collateral channel to the distal cap of CTO, the success rate of recanalization was 94.1%. In patient with failure to cross the collaterals, the success rate was 62.5%. Eight different kinds of retrograde techniques were used： kissing wire technique （35.3%）, wire trapped and reverse wire trapped technique （17.6%）, back-end balloon and microcatherer reversal technique （14.7%）, controlled antegrade and retrograde subintimal tracking （CART） technique （8.8%）, reverse CART and modified reverse CART technique （8.8%）, retrograde wire crossing technique （2.9%）. There were 4 complications occurred without in-hospital major adverse cardiac events （MACE）. In-hospital MACE was 7.7%. All of them were non-Q wave myocardial infarction. There were no cases of death or target vessel revascularization, either surgery or percutaneous.Conclusions The retrograde approach can be an effective tool for increasing the success rate of recanalization in the very complex CTO. To ensure the success and safety of the approach, careful case selection and device handling by experienced operators is essential.
文摘Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2009, 195 （41.1%） patients with 254 （47.0%） bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal （n=134） and distal （n=-120） groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization （TVR）. Results Collaterals with Rentrop class 3 were seen more in distal group （100% and 68.3%）, compared to proximal group （76.9% and 45.6%）. Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group （6.7%, P 〈0.001）, without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group （P=0.044）. Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization （HR 2.028, P=0.049, 95% CI 1.002-4.105） and post-stenting TIMI flow （HR 6.122, P=0.020, 95% Cl 1.334-28.092） were two independent predictors of composite MACE at the 1-year follow-up. Conclusions Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcom
文摘经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是治疗冠状动脉粥样硬化性心脏病(冠心病)的常用方法。冠状动脉慢性完全闭塞(chronic total occlusion,CTO)是PCI最具挑战的病变之一,且术后并发症发生率较高[1]。PCI过程中导丝嵌顿属于罕见并发症,与冠状动脉病变复杂性和医师操作等有关,处理不当可致嵌顿的导丝发生断裂。
文摘目的:观察慢性完全闭塞病变(chronic total occlusion,CTO)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)成功对2年生存率的影响。方法:连续入选2005年1月～2010年9月在我院心内科住院共700例稳定型心绞痛患者,其中84例(12%)为CTO患者。按照CTO病变成功开通组(开通组)或未成功开通组(未开通组)分层观察患者2年生存率。住院期间主要不良心脏事件(MACE)发生率,MACE包括心肌梗死、紧急血运重建、卒中或死亡。结果:未开通组先前进行血运重建治疗的患者比例显著大于开通组(PCI分别为36%vs.21%,P<0.01),两组的其他基线特征相似。术中并发症(包括冠状动脉夹层)在未开通组患者中更常见(分别为30.8%vs.10.3%;P<0.05),但没有影响院内MACE事件发生率(分别为3%和2%,P>0.05)。开通组2年生存率显著高于未开通组(96%vs.83%,P<0.01)。多因素分析显示手术成功为死亡概率的独立预测因子(HR:0.32,95%CI:0.18-0.58,P<0.01)。结论:CTO病变PCI术后开通组的2年生存率较未开通组显著提高。
文摘Although the retrograde approach was a promising strategy for chronic total occlusions(CTO)-percutaneous coronary interventions(PCI),[1]with the development of coronary interventional therapy technology and interventional instruments,antegrade dissection and re-entry(ADR)are commonly employed in PCI to open CTO of coronary arteries.
文摘慢性完全闭塞性病变(chronic total occlusions,CTO)在行冠状动脉造影的患者中非常普遍。观察性的研究显示,成功开通CTO可以改善患者生活质量,提升心血管病患者临床预后。但由于缺乏随机试验,其临床获益仍然存在争论。最新的欧洲心脏病协会指南仍然将CTO患者行PCI治疗推荐为Ⅱa类(B级证据)。
