预置延长导管辅助逆向微导管通过侧支血管的临床研究

Preset extension catheter assisting reverse microcatheter passing through collateral vessels:a clinical study

目的观察在复杂冠状动脉(冠脉)慢性完全闭塞病变(CTO)介入治疗中使用逆向指引导管内主动预置延长导管方法对逆向微导管通过侧支血管的安全性和有效性的影响。方法入选2017年1月至2020年6月就诊于解放军第三O五医院,J-CTO评分3分以上的单支CTO患者67例,采用逆向介入策略,以室间隔支为侧支血管。术前进行按数字序列进行分组,分为主动预置延长导管组(APE组)32例和常规组35例,比较两组之间临床基线资料、血管病变及侧支血管特征、手术相关参数、介入相关参数及围手术期并发症。结果APE组初次成功率显著高于常规组(90.63%vs.57.14%,P<0.05),逆向介入失败率低于常规组(3.13%vs.8.57%,P<0.05),与常规组比较围手术期并发症发生率未见增加,在APE组手术时间、微导管使用数量以及通过侧支血管时间明显低于常规组(P均<0.05),常规组初次失败后被动选用分支锚定、延长导管和侧支血管扩张的使用率明显增高(P均<0.05)。结论采用逆向指引导管内主动预置延长导管方法可以显著提高逆向微导管通过侧支血管的能力,缩短手术时间,提高手术效率,且不增加并发症风险,具有较好的临床实用价值。

Objective To observe the influence on the safety and efficacy of active preset extension catheter(APE)in reverse microcatheter passing through collateral vessels during the intervention treatment for complex chronic total occlusion of coronary artery(CTO).Methods The patients(n=67)with single-vessel CTO with J-CTO scores more than 3 were chosen from Chinese PLA the 305th Hospital from Jan.2017 to June 2020.A reverse intervention strategy was used and ventricular septal branches were taken as collateral vessels.Before the operation all patients were divided in APE group(n=32)and routine group(n=35)according to digital random method.The clinical baseline data,vascular lesions,collateral vessel characteristics,operation-related parameters,intervention-related parameters and perioperative complications were compared between 2 groups.Results The initial success rate was significantly higher(90.63%vs.57.14%,P<0.05)and failure rate of reverse intervention was lower(3.13%vs.8.57%,P<0.05)in APE group than those in routine group.The incidence rates of perioperative complications did not increase.The operation duration,used numbers of microcatheters and time to pass through collateral vessels were significantly lower in APE group than those in routine group(all P<0.05).In routine group,the utilization rates of passive branch anchoring,extension catheters and collateral vasodilation were significantly higher after the initial failure(all P<0.05).Conclusion APE in reverse guiding catheter can significantly promote the ability of reverse microcatheter passing through collateral vessels,shorten operation duration,improve operation efficacy and does not increase complication risk with higher clinical practical value.