完全经桡动脉与经股动脉入路在冠状动脉慢性完全闭塞病变逆向经皮冠状动脉介入治疗中的比较

Comparisons of transradial and transfemoral for percutaneous coronary interventions on chronic total occlusions via retrograde approach

目的探讨完全经桡动脉途径(fully transradial approach,fTRA)在冠状动脉慢性完全闭塞性病变(chronic total occlusion,CTO)逆向经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的可行性。方法本研究连续入选2015年1月至2019年6月于东莞康华医院及广东省人民医院南海分院住院行冠状动脉造影明确为CTO并行逆向PCI治疗的患者。收集两组患者临床、血管及介入治疗的资料,同时对比fTRA及经股动脉途径(transfemoral approach,TFA)在J-CTO评分及逆向CTO评分下介入治疗成功率、效率及安全性。结果本研究共纳入682例行逆向PCI治疗的CTO患者,其中fTRA组173例,TFA组509例。fTRA和TFA组不同J-CTO评分患者的手术成功率比较,差异无统计学意义(P>0.05)。fTRA和TFA组逆向CTO评分0分患者手术成功率比较,差异亦无统计学意义(99%vs.99%,P=0.998)。而fTRA和TFA组逆向CTO评分1分(87%vs.92%,P=0.022)及2~3分(63%vs.72%,P<0.001)患者中,TFA组手术成功率较高,差异具有统计学意义。结论逆向CTO评分能协助逆向CTO介入治疗入路的选择:对于低分组,fTRA安全有效;而对于复杂逆向CTO介入治疗,应酌情考虑TFA。

Objectives To evaluate the feasibility of fully transradial approach(fTRA)in retrograde technique for chronic total occlusion(CTO)recanalization.Methods We retrospectively collected CTO cases applying retrograde percutaneous coronary intervention(PCI)from January 2015 to June 2019 in Dongguang Kanghua Hospital and Guangdong General Hospital’s Nan-Hai Hospital.The clinical and angiographic characteristics,procedural details,and outcomes were examined.J-CTO score and Retro-CTO score were applied to distinguish success rate,efficacy and safety via transfemoral approach(TFA)and fTRA.Results There were 682 cases enrolled in this study,among which,173 cases in fTRA group and 509 cases in TFA group.The technical success rates of patients with different J-CTO score between fTRA group and TFA group had no significant difference(P>0.05).The technical success rates of patients with Retro-CTO score 0 between fTRA group and TFA group also had no significant difference(99%vs.99%,P=0.998).The technical success rates of patients with Retro-CTO score 1(87%vs.92%,P=0.022)and 2-3(63%vs.72%,P<0.001)in TFA group were significantly higher than those in fTRA group.Conclusions Retro-CTO score could help to identify suitable candidates for the treatment of CTO via the transradial approach:fTRA may be feasible in noncomplex cases.Otherwise,TFA should be considered.