崔磊,黄宜杰,李旭东,路雯,王海波,李振勇,韩冰

• 1:徐州市中心医院心内科

摘要(Abstract)：

目的探讨对慢性完全闭塞(CTO)病变重新尝试经皮冠状动脉介入治疗(PCI)的策略和技术。方法连续入选2016年9月至2019年12月徐州市中心医院心内科住院行PCI的CTO病变患者258例,分为首次尝试组(206例)和重新尝试组(52例),分析与首次尝试组相比,重新尝试组的手术策略和技术以及临床结局的异同。结果重新尝试组靶病变解剖结构更为复杂,J-CTO评分高于首次尝试组[(3.2±1.1)分比(1.8±0.9)分,P<0.001]。重新尝试组器械成功率较首次尝试组偏低(76.9%比88.3%,P=0.034)。两组患者在手术策略方面比较:重新尝试组正向策略应用比例低于首次尝试组(71.2%比88.3%,P=0.002),而双向策略应用则高于首次尝试组(23.1%比7.8%,P=0.002),但在双向失败转正向策略应用上两组差异无统计学意义(5.8%比3.9%,P=0.467)。重新尝试组在平行导丝技术(43.2%比25.8%,P=0.033)、正向内膜下重回真腔技术(8.1%比0.5%,P=0.016)、血管内超声指导的正向技术(16.2%比3.8%,P=0.011)、反向控制性正向和逆向内膜下寻径技术(21.6%比2.2%,P<0.001)、抓捕技术(10.8%比1.6%,P=0.017)、Knuckle技术(8.1%比0.5%,P=0.016)的应用比例较多。两组患者冠状动脉穿孔以及住院期间主要不良心血管事件发生率比较,差异均无统计学意义(均P>0.05)。结论重新尝试的CTO-PCI,由于病变复杂,手术难度高,成功率较首次尝试组偏低。对于有经验的术者,通过分析首次尝试失败原因,可以更有针对性地制定手术策略和及时转换策略,并合理运用相关技术,仍可以取得较高的成功率。

关键词(KeyWords)： 慢性完全闭塞;经皮冠状动脉介入治疗;重新尝试;策略和技术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 崔磊,黄宜杰,李旭东,路雯,王海波,李振勇,韩冰

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