22例前向PCI失败但逆向成功CTO病例分析

A clinical analysis of 22 cases anterograde PCI failed to retrograde PCI successful therapy in chronic coronary total occlusion

目的 探讨逆向导丝技术治疗前向失败的冠状动脉慢性完全闭塞（chronic total occlusion， CTO）病变的可行性和安全性。方法选择2008年6月至2011年12月在本院住院治疗的22例冠心病患者，年龄51～68（59±7）岁，男15例，女7例。冠状动脉造影显示冠状动脉CTO，其中14例右冠状动脉CTO，8例左冠状动脉前降支CTO。常规行前向导丝技术失败后，采用逆向导丝技术行冠状动脉介入治疗，观察手术成功率、手术时间、X线曝光时间、造影剂用量、并发症和主要不良心脏事件（包括心源性死亡、心肌梗死、靶病变血运重建）。结果20例患者行逆向导丝技术成功，成功率为90.9%，手术时间为112～226（162±35）分钟、X线曝光时间为54～98（72±20）分钟、造影剂用量为180～290（236±27）ml、无心源性死亡和其他严重并发症发生。患者随访3～36个月，2例患者再发心绞痛，复查冠状动脉造影示：1例出现支架内再狭窄，另1例为非靶血管狭窄。结论当前向导丝技术不能通过CTO时，应用逆行导丝技术是可行和安全的，可明显提高手术成功率。

Objective To investigate the feasibility and safety of retrograde guidewire therapy in anterograde failed chronic coronary total occlusion (CTO). Methods A total of 22 cases of coronary heart disease with CTO were treated from June 2008 to December 2011 in our hospital, aged 51 ~ 68 (59±7) years of age, 15 males and 7 females. Coronary angiography showed coronary artery CTO, of which 14 were right coronary artery CTO, 8 patients with left anterior descending coronary artery CTO. After a failed antegrade CTO recanalization attempt, a retrograde approach via septal collaterals was tried. Success rate, procedure time, X-ray exposure time, contrast agent, complications and major adverse cardiac events were recorded (including cardiac death, myocardial infarction and target lesion revascularization). Results 20 patients underwent successful retrograde guidewire technique, with a the success rate of 90.9%, procedure time 112~226 (162±35) min, X-ray exposure time of 54 ~ 98 (72±20) min, contrast agent 180 ~ 290 (236±27) ml, without cardiac death and other serious complications. Patients were followed up for 3~36 months. Two patients had recurrent angina. Coronary angiography showed one case of restenosis, and the other non-target vessel stenosis. Conclusions When the antegrade guidewire technique could not be passed along CTO, the retrograde guidewire therapy was feasible and safe, could increase the technical success rate of CTO recanalization attempts.