21例冠状动脉慢性闭塞病变介入治疗成功因素分析  

Successful percutaneous treatment of twenty-one patients with coronary chronic total occlusions

作　　者：姚康[1] 钱菊英[1] 葛雷[1] 杨虹波[1] 王齐冰[1] 樊冰[1] 张书宁[1] 张峰[1] 黄东[1] 陆浩[1] 戴宇翔[1] 李晨光[1] 仲昕[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,上海200032

出　　处：《临床心血管病杂志》2015年第7期758-760,共3页Journal of Clinical Cardiology

摘　　要：目的：对2012年中国冠状动脉慢性闭塞病变俱乐部（CTOCC）入选患者的介入治疗操作成功率及其成功因素进行分析。方法：观察入选CTOCC的21例患者,分析介入治疗过程特点、即刻造影成功率及操作成功率。结果：21例患者均为外院或中山医院首次介入治疗失败者,闭塞时间为3~60个月。所有患者术前均完成冠状动脉（冠脉）CT检查,双侧穿刺造影使用率为100%。其中17例前向导丝通过法成功完成介入治疗,最常使用的技术为平行导引钢丝技术;4例逆向技术成功开通血管,其中3例使用Reverse Cart技术。平均钢丝使用数量为4.24根,术者首先尝试使用软导引钢丝者19例（90.5%）,其中最常使用的是锥形导丝Fielder XT,占（52.6%）,其次为Sion导丝（26.3%）,其中成功者5例（23.8%）,多数需要使用硬导引钢丝通过病变（76.2%）,通过CTO病变术者最常使用的硬导引钢丝为Conquest（42.9%）系列导引钢丝,其次为CrosswireNT导丝（28.6%）。术中微导管使用率为100%,其中Cosair导管最常使用（76.2%）。操作中血管内超声（IVUS）的使用率为42.9%,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以及寻找闭塞血管入口。21支闭塞血管成功植入支架46枚,平均2.19个,均为药物洗脱支架,PCI成功率达100%。住院期间无主要心血管事件发生。结论：2012年CTOCC病例介入治疗全部获得成功,可能与术者术前充分读片,指导操作的辅助检查使用率高,术中合理使用导丝和相关器械,IVUS使用充分有关。Objective：To analyze successful percutaneous recanalization of coronary chronic total occlusion（CTO）patients who had enrolled in 2012 Chronic Total Occlusions Club,China（CTOCC）.Method：Retrospectively access the success recanalization rate and analyze the process features of percutaneous transluminal coronary intervention（PCI）of twenty one patients who had enrolled in 2012 CTOCC and underwent treatment failure for the first time.Result：Mean occlusion duration was 3-60 months.All patients underwent coronary CT examination before PCI.Bilateral angiography was used in all cases.Overall success recanalization rate was 100%（21/21）.Retrograde approach as the primary strategy was applied in 4/21（19%）patients,and retrograde approach immediately after antegrade failure attempt was performed in 2/21 patients.17patients were successfully recanalized through antegrade approach（81%）.The soft wires were used as the first attempt wire in 90.5%（19/21）of patients and five patients were successfully recanalized,in which Fielder XT was most commenly used（52.6%）,and the usage of Sion（26.3%）ranks next.Stiff wires were commonly used during CTO（16/21,76.2%）,where Conquest（42.9%）and CrosswireNT（28.6%）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 was the most commonly used.The application rate of intravascular ultrasound（IVUS）was 42.9%.There were no in hospital major adverse cardiac events during the follow up.Conclusion：To a certain extent,the high success recanalization rate during 2012 CTOCC is related to the fully read coronary angiogram before operation,the high application rate of coronary CT and IVUS,and the rational use of guide wires during PCI procedure.

关 键 词：冠状动脉慢性闭塞病变 介入治疗 临床研究 

分 类 号：R543.3[医药卫生—心血管疾病]