Expressman锥形延长导管在冠状动脉慢性完全性闭塞病变中的应用  

Application of Expressman tapered extension catheter in chronic total occlusion of coronary artery

作　　者：廖建泉 石怀瑞 吴润达 马元吉 张蒙 陈瑶琳 姚康 葛均波 LIAO Jian-quan;SHI Huai-rui;WU Run-da;MA Yuan-ji;ZHANG Meng;CHEN Yao-lin;YAO Kang;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,China)

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：《中国临床医学》2023年第4期567-571,共5页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81300096,82170460);国家临床重点专科建设项目(YW2021-002);上海市临床重点专科建设项目(shslczdzk06201).

摘　　要：目的探讨Expressman锥形延长导管在治疗冠状动脉慢性完全性闭塞(chronic total occlusion,CTO)病变中的有效性和安全性。方法回顾性选择2021年5月至2023年5月复旦大学附属中山医院接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠状动脉CTO患者228例,根据使用延长辅助导管类型分为5F Expressman延长导管组(5F组,n=97)和5-4F Expressman锥形延长导管组(5-4F组,n=131)。比较两组患者人口学特征、介入操作治疗相关指标及住院期间主要不良心血管事件(major adverse cardiovascular events,MACEs)。结果两组患者的年龄、性别、吸烟史、PCI史、冠状动脉旁路移植术(coronary artery bypass grafting,CABG)史、既往心肌梗死史比例差异无统计学意义。CTO病变血管中,右冠状动脉比例最高(65.4%),其次是前降支(26.3%);中位J-CTO评分为3(2,3)分。5-4F组的导管深插长度显著高于5F组[(43.9±18.3)mm vs(29.7±21.3)mm,P<0.001]。5-4F组术中的压力嵌顿发生率显著低于5F组(3.1%vs 9.3%,P=0.045),5-4F组的器械通过成功率显著高于5F组(97.7%vs 90.7%,P=0.019)。两组患者住院期间均未观察到MACEs。结论5-4F Expressman锥形延长导管在冠脉CTO介入治疗中的应用可提高器械输送成功率,减少压力嵌顿的发生。Objective To explore the effectiveness and safety of the Expressman tapered extension catheter in the treatment of coronary artery chronic total occlusion(CTO).Methods A total of 228 patients with coronary CTO who used extension catheters during percutaneous coronary intervention(PCI)in Zhongshan Hospital,Fudan University from May 2021 to May 2023 were retrospectively selected.The patients were divided into 5F Expressman extension catheter group(5F group,n=97)and 5-4F Expressman tapered extension catheter group(5-4F group,n=131).The demographic characteristics,data related to interventional procedure and major adverse cardiovascular events(MACEs)during hospitalization were compared between the two groups.Results There were no significant differences in age,gender,smoking history,PCI history,coronary artery bypass grafting(CABG)history,or previous myocardial infarction between the two groups.The most common lesion of CTO was the right coronary artery(65.4%),followed by the left anterior descending artery(26.3%).The median J-CTO score was 3(2,3).The intubation depth of the 5-4F group was significantly higher than that of the 5F group([43.9±18.3]mm vs[29.7±21.3]mm,P<0.001).The incidence of intraoperative pressure damping in 5-4F group was significantly lower than that in 5F group(3.1%vs 9.3%,P=0.045),and the success rate of device delivery in 5-4F group was significantly higher than that in 5F group(97.7%vs 90.7%,P=0.019).No MACEs were observed during hospitalization in both groups.Conclusions The application of the Expressman tapered extension catheter in interventional therapy of CTO lesions can improve the success rate of device delivery and reduce the occurrence of pressure damping.

关 键 词：经皮冠状动脉介入治疗 延长导管 冠状动脉慢性完全性闭塞 

分 类 号：R543.3[医药卫生—心血管疾病]