李金,高好考,王欢,王博,夏陈海,刘海涛,廉坤,张亚敏,杨丽,赵帅,杨华,陶凌,李成祥

• 1:中国人民解放军空军军医大学第一附属医院心血管内科

摘要(Abstract)：

目的 观察复合策略在慢性完全闭塞（CTO）病变经皮冠状动脉介入治疗（PCI中的应用结果，评价其有效性和安全性。方法 连续纳入2018年1月至2020年12月于中国人民解放军空军军医大学第一附属医院心血管内科接受单名经验丰富术者实施CTO-PCI的患者，收集其临床特征、冠状动脉造影特征、术中结果、院内结局等资料，分析总成功率、不同日本多中心CTO注册研究（J-CTO）评分的治疗结果、复合策略应用结果、失败原因以及院内主要不良心脑血管事件（MACCE）发生率。结果 共891例患者接受1 010例次CTO-PCI，男性比例87.3%，平均年龄（61±11）岁，平均J-CTO评分为（2.5±1.2）分。总体CTO-PCI成功率为94.8%(957/1 010),J-CTO≤1分、=2分、≥3分CTO-PCI的成功率分别为99.5%(205/206)、96.9%(222/229)、92.2%(530/575)。平均使用策略（1.2±0.5）次，首选策略中，正向最为常用（85.0%,858/1 010），其次是逆向（13.0%,131/1 010）和正向夹层重入（ADR;2.1%,21/1 010）。正向、逆向、ADR最终CTO-PCI成功率分别为74.6%(648/869)、83.2%(227/273)、84.5%(82/97)，在总成功CTO-PCI中的占比分别为67.7%(648/957)、23.7%(227/957)、8.6%(82/957)。院内MACCE发生率为0.9%(9/1010)。中位导丝操控时间为29(10,60)min,PCI时间为102(69,145)min,X线透视时间为47(34,68)min，对比剂用量为350(270,430)ml，辐射剂量为3.3(2.1,4.8) Gy，空气比释动能-面积乘积为31(21,46)Gy·cm2。结论 经验丰富的术者遵循复合策略实施CTO-PCI，可获得很高的成功率及较低的院内MACCE发生率。

关键词(KeyWords)： 慢性完全闭塞;经皮冠状动脉介入治疗;复合策略;正向夹层重入

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李金,高好考,王欢,王博,夏陈海,刘海涛,廉坤,张亚敏,杨丽,赵帅,杨华,陶凌,李成祥

参考文献(References)：

• [1] Fefer P,Knudtson ML,Cheema AN,et al. Current perspectives on coronary chronic total occlusions:the Canadian Multicenter Chronic Total Occlusions Registry[J]. J Am Coll Cardiol,2012,59(11):991-997. DOI:10.1016/j.jacc.2011.12.007.
• [2] Azzalini L,Jolicoeur EM,Pighi M,et al. Epidemiology,management strategies,and outcomes of patients with chronic total coronary occlusion[J]. Am J Cardiol,2016,118(8):1128-1135. DOI:10.1016/j.amjcard.2016.07.023.
• [3] Ozawa N. A new understanding of chronic total occlusion from a novel PCI technique that involves a retrograde approach to the right coronary artery via a septal branch and passing of the guidewire to a guiding catheter on the other side of the lesion[J]. Catheter Cardiovasc Interv,2006,68(6):907-913. DOI:10.1002/ccd.20882.
• [4] Suh J,Cho YH,Lee NH. Bail-out reverse controlled antegrade and retrograde subintimal tracking accompanied by multiple complications in coronary chronic total occlusion[J]. J Invasive Cardiol,2008,20(12):E334-E337.
• [5] Whitlow PL,Burke MN,Lombardi WL,et al. Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques:results of the FAST-CTOs(facilitated antegrade steering technique in chronic total occlusions)trial[J]. JACC Cardiovasc Interv,2012,5(4):393-401. DOI:10.1016/j.jcin.2012.01.014.
• [6]赵林，王刚，胡春阳，等. Stingray球囊辅助下正向夹层再进入技术在慢性完全闭塞病变治疗中的应用[J].中国介入心脏病学杂志，2020,28(9):511-516. DOI:10. 3969/j. issn.1004-8812. 2020. 09. 007.
• [7] Brilakis ES,Grantham JA,Rinfret S,et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions[J]. JACC Cardiovasc Interv,2012,5(4):367-379. DOI:10.1016/j.jcin.2012.02.006.
• [8] Maeremans J,Walsh S,Knaapen P,et al. The hybrid algorithm for treating chronic total occlusions in europe:the RECHARGE registry[J]. J Am Coll Cardiol,2016,68(18):1958-1970. DOI:10.1016/j.jacc.2016.08.034.
• [9]葛均波，葛雷，霍勇，等.中国冠状动脉慢性完全闭塞病变介入治疗推荐路径更新[J].中国介入心脏病学杂志，2021,29(6):302-305. DOI:10. 3969/j. issn. 1004-8812. 2021. 06. 002.
• [10] Wu EB,Tsuchikane E,Ge L,et al. Retrograde versus antegrade approach for coronary chronic total occlusion in an algorithmdriven contemporary Asia-Pacific multicentre registry:comparison of outcomes[J]. Heart Lung Circ,2020,29(6):894-903. DOI:10.1016/j.hlc.2019.05.188.
• [11] Jakub D,Kowalski M,Wo?yniak T,et al. The hybrid algorithm in treatment of coronary chronic total occlusions-MSWiA Lublin CTO 5-year registry[J]. Postepy Kardiol Interwencyjnej,2020,16(3):269-277. DOI:10.5114/aic.2020.99261.
• [12] Tajti P,Karmpaliotis D,Alaswad K,et al. The hybrid approach to chronic total occlusion percutaneous coronary intervention:update from the PROGRESS CTO registry[J]. JACC Cardiovasc Interv,2018,11(14):1325-1335. DOI:10.1016/j.jcin.2018.02.036.
• [13] Rathore S,Khanra D,Galassi AR,et al. Procedural characteristics and outcomes following chronic total occlusion coronary intervention:pooled analysis from 5 registries[J].Expert Rev Cardiovasc Ther,2021,19(10):929-938.DOI:10.1080/14779072.2021.1997590.
• [14] Tanaka H,Tsuchikane E,Muramatsu T,et al. A novel algorithm for treating chronic total coronary artery occlusion[J]. J Am Coll Cardiol,2019,74(19):2392-2404. DOI:10.1016/j.jacc.2019.08.1049.
• [15] Wu EB,Brilakis ES,Mashayekhi K,et al. Global chronic total occlusion crossing algorithm:JACC state-of-the-art review[J]. J Am Coll Cardiol,2021,78(8):840-853. DOI:10.1016/j.jacc.2021.05.055.
• [16] Nikolakopoulos I,Vemmou E,Karacsonyi J,et al. Latest developments in chronic total occlusion percutaneous coronary intervention[J]. Expert Rev Cardiovasc Ther,2020,18(7):415-426. DOI:10.1080/14779072.2020.1787153.
• [17] Galassi AR,Sumitsuji S,Boukhris M,et al. Utility of intravascular ultrasound in percutaneous revascularization of chronic total occlusions:an overview[J]. JACC Cardiovasc Interv,2016,9(19):1979-1991. DOI:10.1016/j.jcin.2016.06.057.
• [18] Suzuki Y,Tsuchikane E,Katoh O,et al. Outcomes of percutaneous coronary interventions for chronic total occlusion performed by highly experienced Japanese specialists:the first report from the Japanese CTO-PCI Expert Registry[J]. JACC Cardiovasc Interv,2017,10(21):2144-2154. DOI:10.1016/j.jcin.2017.06.024.
• [19] Miura K,Tanaka H,Kishi K,et al. Impact of timing and treatment strategy on coronary perforation during percutaneous coronary intervention for chronic total occlusion[J]. Am J Cardiol,2022,172:26-34. DOI:10.1016/j.amjcard.2022.02.019.
• [20] Lee K,Lee PH,Lee SW,et al. Primary versus rescue retrograde approach for chronic total coronary occlusion[J].Catheter Cardiovasc Interv,2022,99(2):219-225. DOI:10.1002/ccd.30023.
• [21]葛均波，霍勇，汝磊生.正向夹层再入真腔技术在冠状动脉慢性完全闭塞病变介入治疗中应用中国专家共识[J].中国介入心脏病学杂志，2021,29(10):541-547. DOI:10. 3969/j. issn. 1004-8812. 2021. 10. 001.
• [22] Xenogiannis I,Alaswad K,Krestyaninov O,et al. Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion percutaneous coronary intervention[J]. Rev Esp Cardiol(Engl Ed),2021,74(12):1023-1031. DOI:10.1016/j.rec.2020.09.009.
• [23] Hall AB. Preprocedure planning for chronic total occlusion percutaneous coronary intervention:the separation is in the preparation[J]. Interv Cardiol Clin,2021,10(1):7-23.DOI:10.1016/j.iccl.2020.09.003.
• [24] Opolski MP,Nap A,Knaapen P. A computed tomography algorithm for crossing coronary chronic total occlusions:riding on the wave of the proximal cap and distal vessel segment[J]. Neth Heart J,2021,29(1):42-51. DOI:10.1007/s12471-020-01510-1.
• [25] Kinnaird T,Gallagher S,Cockburn J,et al. Procedural success and outcomes with increasing use of enabling strategies for chronic total occlusion intervention[J]. Circ Cardiovasc I n t e r v, 2 0 1 8, 11(1 0):e 0 0 6 4 3 6. D O I:1 0. 11 6 1/circinterventions.118.006436.