Stingray球囊辅助下正向夹层再进入技术在慢性完全闭塞病变治疗中的应用

Clinical application of Stingray balloon assistant antegrade dissection and reentry for percutaneous coronary intervention of chronic total occlusion

目的比较直接正向夹层再进入技术(ADR)和补救性ADR治疗慢性完全闭塞(CTO)病变的成功率、疗效和安全性。方法2017年1月至2019年12月连续入选北京安贞医院和中国人民解放军联勤保障部队980医院使用Stingray球囊辅助ADR治疗的CTO患者。根据ADR使用的时机分为直接ADR组和补救性ADR组,比较两组患者的临床资料、病变特点、操作过程、手术成功率及住院期间的主要不良心脑血管事件(MACCE)。结果总计入选243例ADR治疗的CTO病变患者,其中直接ADR组127例,补救性ADR组116例。直接ADR组ADR手术成功率高于补救性ADR组(89.0%比77.6%,P=0.017),直接ADR组手术时间[89(42,190)min比145(72,213)min]、曝光时间[35(22,164)min比76(38,175)min]、导丝通过CTO病变的时间[32(15,153)min比75(34,165)min]明显短于补救性ADR组;辐射剂量[1.6(0.4,6.9)Gy比3.4(0.8,13.9)Gy]、对比剂用量[175(85,535)ml比255(115,760)ml]明显低于补救性ADR组,差异均有统计学意义(均P<0.001)。直接ADR组住院期间MACCE发生率略低于补救性ADR组,但差异无统计学意义(2.4%比5.2%,P=0.428)。结论Stingray球囊辅助下ADR开通CTO病变安全高效。与补救性ADR比,直接ADR提高了ADR的成功率和手术效率,在适宜ADR介入治疗的CTO病变中,建议使用直接ADR。

Objective To compare the success rate,effi ciency and safety of primary and bailout antegrade dissection and reentry(ADR)for percutaneous coronary intervention(PCI)of chronic total occlusions(CTO).Methods Patients underwent stingray balloon assistant ADR for PCI of CTO in Beijing Anzhen Hospital and the 980th Hospital of Joint Support Force of PLA were continuously enrolled in this registry from January 2017 to December 2019.All patients were divided into primary and bailout ADR group according to the starting time of ADR during the PCI of CTO.Clinical data,lesion characteristics,PCI procedure,success rate and in-hospital major adverse cardiovascular and cerebrovascular events(MACCE)were compared between the two groups.Results A total of 243 patients were enrolled in our registry among whom there were 127 primary ADR patients and 116 bailout ADR patients.Success rate of ADR in primary ADR group was obviously higher than bailout group(89.0%vs.77.6%,P=0.017).Operation time[89(42,190)min vs.145(72,213)min],radiation time[35(22,164)min vs.76(38,175)min]and guidewire crossing CTO time[32(15,153)min vs.75(34,165)min]in primary ADR group were lower than bailout ADR group(All P<0.001).Radiation dose[1.6(0.4,6.9)Gy vs.3.4(0.8,13.9)Gy]and contrast volume[175(85,535)ml vs.255(115,760)ml]in primary ADR group were lower than bailout group(All P<0.001).In-hospital MACCE in primary and bailout ADR groups were 2.4%and 5.2%and the diff erence between primary and bailout ADR groups had no statistical signifi cance(P=0.428).Conclusions Stingray balloon assistant ADR is a safe and effi cient approach for treatment of CTO lesions.Compared with bailout ADR,primary ADR improves ADR success rate and operation effi ciency which can be used as fi rst PCI strategy for appropriate CTO lesions.