改良的内膜下斑块修饰技术对经皮冠状动脉介入治疗慢性完全性血管闭塞病变再通率的影响

Modified subintimal plaque modification improving recanalization in percutaneous coronary intervention for chronic complete vascular occlusion

目的比较改良内膜下斑块修饰技术(Subintimal plaque modification,SPM)与传统SPM的安全性和有效性。方法连续入选2015年1月至2019年12月于我院住院治疗的慢性完全性血管闭塞患者,经皮冠状动脉介入治疗失败后行SPM治疗。最终入组54例患者,其中改良SPM组患者22例,传统SPM组患者32例。对两组患者的预后进行分析,主要终点是血管再通率。血管再通率的定义为行介入治疗30~90d内血管TIMI血流是否可能达到2~3级。结果两组基线资料无显著性差异。对比随访结果,改良SPM血管再通率明显高于传统SPM(90.9%比62.5%,P<0.05)。改良SPM组的手术策略更激进一些,包括应用更大尺寸的球囊[(1.83±0.30)mm比(2.48±0.26)mm,P<0.05]和更长段的内膜下血管成形术范围[(0.59±0.16)mm比(0.92±0.12)mm,P<0.05]。而且,在改良SPM组中,更普遍的应用Stingray球囊和延长导管,可以明显地改善患者的预后。改良SPM组15例患者完成术后1年造影随访,未发现靶病变失败的情况,无需行进一步治疗。结论改良SPM血管再通率高,是治疗慢性完全性血管闭塞病变有效、安全的手术方式。

Objective To compare the safety and efficacy of modified subintimal plaque modification(SPM)with traditional SPM.Methods A total of 1454 consecutive patients who failed a chronic total occlusion percutaneous coronary intervention(CTO PCI)attempt and underwent SPM from January 2015 to December 2019 at our hospital were reviewed retrospectively.Fifty-four patients who underwent SPM finally were included in this study(22 cases in the modified SPM group and 32 cases in the traditional SPM group).The outcomes of all the patients were analyzed.The primary endpoint was recanalization rate,which was defined as thrombolysis in myocardial infarction(TIMI)grades 2~3 flow on angiography within 30 to 90 days after the procedure.Results The baseline characteristics of the two groups were similar.In the follow-up,the recanalization rate was noticeably higher in the modified SPM group compared with the traditional SPM group(90.9%vs.62.5%,P<0.05).The proposed strategy in the modified group was more aggressive,including a larger balloon size[(1.83±0.30)mm vs.(2.48±0.26)mm,P<0.05]and longer subintimal angioplasty[(0.59±0.16)mm vs.(0.92±0.12)mm,P<0.05].Also,the common use of a Stingray balloon and guide catheter extension resulted in improvement of patients’prognoses in the modified SMP group(100%vs.12.5%,P<0.05).The 15 patients in the modified SPM group were followed-up by coronary angiography for 1 year and there was no required further treatment in target lesions.Conclusion Modified SPM,which is associated with a high likelihood of successful recanalization,is an effective and safe CTO PCI strategy.