内膜下斑块修饰技术在开通冠状动脉慢性闭塞中的应用及两年随访结果

Application of subintimal plaque modification in opening coronary chronic total occlusion and two-year follow-up result

目的:冠状动脉慢性闭塞病变(CTO)的介入治疗是当前的热点和难点之一,当CTO病变介入治疗失败或潜在风险超过预期获益时,内膜下斑块修饰技术(SPM)可以成为一项替代性的策略选择。本研究意在探讨应用SPM技术,其实施的安全性和有效性。方法:本研究连续性入选自2015年1月至2019年12月,于我院行冠状动脉造影提示为CTO病变,并在后续手术过程中行SPM技术的患者。主要终点为30~90d内复查冠状动脉造影时的血管再通。次要终点为靶病变血运重建成功。安全性终点为围术期严重并发症发生率。同时对患者行SPM术后24个月进行门诊或电话随访,随访终点为症状驱动的靶血管再次血运重建的发生。结果:自2015年1月至2019年12月,共54例患者(54例病变)纳入本研究,其中有22例纳入改良SPM技术组,32例纳入传统的SPM技术组。主要终点为传统SPM技术组为20例(62.5%),而改良SPM技术组为20例(90.9%)(P<0.05),改良SPM技术组血管再通率显著更高。次要终点传统SPM技术完成26例(81.3%),改良SPM组完成21例(95.9%),两组差异无统计学意义。随访终点传统SPM组共有5例患者完成了因症状驱动的靶血管再次血运重建,而改良SPM组为2例,两组差异无统计学意义。结论:在尝试开通CTO病变的过程中,若开通该病变潜在的风险已经大于获益,可以采用SPM技术,在随访时再次尝试开通病变,血管再通率和血运重建成功率均较高,且长期随访显示该技术的有效性可以得到保证。

Objective:Interventional therapy of chronic total occlusion(CTO)is one of the current hotspots and difficulties.When the interventional therapy of CTO fails or the potential risk exceeds the expected benefit,subintimal plaque modification(SPM)can become an alternative strategic choice.The purpose of this study is to explore the safety and effectiveness of the application of SPM technology.Methods:Patients who underwent coronary angiography in our hospital from January 2015 to December 2019 and underwent SPM in the follow-up operation were selected in this study.The primary end point was recanalization during coronary angiography within 30-90 days.The secondary endpoint was successful revascularization of the target lesion.The safety endpoint was the incidence of serious perioperative complications.At the same time,the patients were followed up by outpatient or telephone 24 months after SPM.The end point of follow-up was the occurrence of symptom driven target vessel revascularization.Results:From January 2015 to December 2019,a total of 54 patients(54 lesions)were included in this study,including 22 in the modified SPM technology group and 32 in the traditional SPM technology group.The primary end point was 20 cases(62.5%)in the traditional SPM group and 20 cases(90.9%)in the modified SPM group(P<0.05).The secondary end point was completed by traditional SPM technique in 26 cases(81.3%)and improved SPM group in 21 cases(95.9%).There was no significant difference between the two groups.At the end point of followup,a total of 5 patients in the traditional SPM group completed the revascularization of target vessels driven by symptoms,while 2 patients in the improved SPM group had no significant difference.Conclusions:In the process of trying to open CTO lesions,if the potential risk of opening the lesions is greater than the benefit,SPM technology can be used.If you try to open the lesions again during follow-up,the vascular recanalization rate and the success rate of revascularization are high,and the long-term follow-up shows that the effectiveness of this technology can be guaranteed.