微导管同侧双重造影术在CTO病变前向介入治疗中的应用研究

Application of Microcatheter Ipsilateral Double Contrast Angiography in Anterior Interventional Therapy of CTO Lesions

【目的】探讨微导管同侧双重造影术在冠状动脉慢性完全闭塞(CTO)前向经皮冠脉介入治疗(PCI)中的应用价值。【方法】回顾性分析2018年1月至2019年12月于本院行冠状动脉造影确诊为CTO的患者,30例患者均应用前向技术,其中微导管同侧双重造影13例(观察组),常规双侧造影17例(对照组)。比较两组冠脉造影情况、J-CTO积分、X线曝光时间、PCI总时间、造影剂用量、手术并发症发生率、动脉穿刺并发症、30 d主要心血管不良事件(MACE)和次要终点事件发生率及射血分数(LVEF)。【结果】两组患者J-CTO评分及冠脉病变支数、左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)所占比例比较,差异均无统计学意义(P>0.05)。两组X线曝光时间、PCI总时间、手术并发症、动脉穿刺并发症比较,差异无统计学意义(P>0.05)。观察组造影剂用量低于对照组,差异有统计学意义(P<0.05)。术后30 d,两组患者MACE事件、次要终点事件发生率及LVEF比较,差异均无统计学意义(P>0.05)。【结论】在CTO病变的前向PCI治疗过程中,应用微导管同侧双重造影术可较好的指导PCI手术过程,且不增加手术难度,同时还可减少患者造影剂的使用量,降低动脉穿刺并发症的风险。

【Objective】To investigate the application value of microcatheter ipsilateral double angiography in patients with chronic total occlusion(CTO)undergoing anterior percutaneous coronary intervention(PCI).【Methods】Retrospective analysis was made on the patients diagnosed as J-CTO by coronary angiography in our hospital from January 2018 to December 2019.All 30 patients were treated with forward technique,including 13 cases of ipsilateral double angiography with microcatheter(observation group),and 17 cases with routine bilateral angiography(control group).Coronary angiography,J-CTO score,X-ray exposure time,total PCI time,dosage of contrast agent,incidence of surgical complications,complications of arterial puncture,incidence of major adverse cardiovascular events(MACE)and secondary end-point events and ejection fraction(LVEF)were compared between the two groups.【Results】There was no significant difference in J-CTO score,the number of coronary artery lesions,the proportion of left anterior descending artery(LAD),left circumflex artery(LCX),and right coronary artery(RCA)between the two groups(P>0.05).There was no significant difference in X-ray exposure time,total PCI time,operation complications and artery puncture complications between the two groups(P>0.05).The dosage of contrast medium in the observation group was lower than that in the control group(P<0.05).There was no significant difference in MACE events,secondary end-point events and LVEF between the two groups 30 days after operation(P>0.05).【Conclusion】In the process of antegrade PCI Treatment of CTO lesions,the application of microcatheter ipsilateral dual angiography can better guide the process of PCI operation,and does not increase the difficulty of operation.At the same time,it can also reduce the use of contrast media and reduce the risk of complications of arterial puncture.