不同病程冠状动脉完全闭塞病变介入治疗技术的差异分析

Differences in interventional techniques for patients with complete coronary artery occlusion at different durations of disease

目的比较不同病程冠状动脉完全闭塞病变介入治疗技术的差异。方法选择2017年1月至2018年6月梅州市中医医院收治的冠状动脉完全闭塞并行介入治疗的患者50例,根据病程分为非慢性完全闭塞(Non-CTO)组(32例)和慢性完全闭塞(CTO)组(18例);对两组患者的冠状动脉病变特征、经皮冠状动脉介入治疗(PCI)术中使用的技术及器械进行回顾性分析。结果两组冠状动脉病变血管数比较,差异未见统计学意义(P>0.05)。病变血管方面,Non-CTO组左前降支病变发生率高于CTO组(P<0.05),而CTO组中左回旋支及右冠状动脉病变发生率高于Non-CTO组(P<0.05)。Non-CTO组患者手术成功者占比(28/32)高于CTO组(13/18),差异有统计学意义(P<0.05);Non-CTO组患者大部分经过桡动脉入路完成手术,而CTO组则大部分需要经股动脉入路完成手术;CTO组在导丝使用数目、使用微导管及对侧造影技术的比例多于Non-CTO组(P<0.05),CTO组中有2例还需经过逆向技术完成手术。结论对冠状动脉慢性完全闭塞患者进行介入操作,技术要求高、成功率低,需要联合多手段完成,如采用股动脉入路为介入治疗提供强支撑,使用不同导丝提高冠状动脉闭塞病变的通过性,使用微导管、对侧造影术及逆向导丝技术等提高手术成功率。

Objective To discuss difference in interventional techniques for patients with different degrees of coronary artery total occlusion. Methods Fifty patients with complete coronary artery occlusion who were treated by interventional therapy in Meizhou Hospital of Traditional Chinese Medicine from January 2017 to June 2018 were selected. And they were divided into Non-CTO group (n=38)and CTO group (n=18) according to the course of disease. Their angiographic features of coronary artery leison, techniques and apparatus applied during treatment procedure were retrospectively analyzed. Results There was no significant difference in the number of vessels between the two groups (P>0.05). In terms of vascular lesions, the incidence of left anterior descending coronary artery lesions in Non-CTO group was higher than that in CTO group (P<0.05), while the incidence of left circumflex artery lesion and right coronary artery lesion in CTO group was higher than that in Non-CTO group (P<0.05). The success rate of operation in Non-CTO group was 28/32, while it was 13/18 in CTO group, and the difference was significant (P<0.05). Most patients in Non-CTO group underwent surgery via radial artery approach (P<0.05), while most patients in CTO group underwent surgery via femoral artery approach (P<0.05). The number of guide wire, ratio of patients using micro catheter and bilateral angiography in CTO group were more than those in Non-CTO group (P<0.05). In CTO group, two patients had to undergo reverse technology to complete the operation. Conclusions The intervention treatment for CTO patients requires high-level technology and low success rate;and it should be accomplished by other techniques, such as using femoral artery approach to provide strong support for interventional therapy, using different wires to improve the throughput rate of coronary artery occlusion lesions, and use of micro catheter, bilateral angiography and retrograde wire technique, so as to improve the success rate of interventional operation.