Corsair微导管与CrossBoss导管引导的正向夹层重入技术在治疗冠状动脉慢性完全闭塞病变中的结果分析

Result Analysis of Antegrade Dissection and Re-entry Technique Guided by Corsair or CrossBoss Microcatheter in the Treatment of Coronary Chronic Total Occlusion

目的:比较采用Corsair微导管和CrossBoss导管引导的正向夹层重入(ADR)技术在冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI)中的应用结果,验证Corsair微导管用于建立内膜下通道的安全性和有效性。方法:连续入选2016年4月至2020年12月于中国人民解放军空军军医大学第一附属医院心血管内科接受CTO PCI并使用Corsair微导管(Corsair组)或CrossBoss导管(CrossBoss组)引导的ADR患者141例,接受符合入选标准的CTO PCI 144例次。记录两组患者的临床资料、CTO靶病变特征、CTO PCI术中结果、院内主要不良心脑血管事件(MACCE)和并发症,并分析组间主要终点ADR技术成功率,次要终点导丝操控时间、PCI时间、策略使用次数、导丝用量、对比剂用量、院内MACCE和并发症的差异。结果:144例次CTO PCI入选本研究,Corsair组和CrossBoss组各72例次。Corsair组技术成功率(94.4%vs.77.8%,P=0.004)、ADR技术成功率(83.3%vs.66.7%,P=0.021)均高于CrossBoss组,而策略使用次数[(2.0±0.6)次vs.(2.2±0.7)次,P=0.017]、导丝用量[(7±3)根vs.(9±3)根,P<0.001]、导丝操控时间[71(48,103)min vs.85(57,139)min,P=0.027]均少于CrossBoss组,两组间PCI时间[146(114,193)min vs.148(94,192)min,P=0.644]和对比剂用量[445(370,535)ml vs.415(320,518)ml,P=0.313]差异均无统计学意义。院内MACCE发生率为4.2%(6/144),ADR相关穿孔发生率为2.1%(3/144),分支丢失率为3.5%(5/144),两组间上述安全指标的差异均无统计学意义(P均>0.05)。结论:相比CrossBoss导管,经验丰富的术者实施Corsair微导管引导的ADR,可获得更高的成功率,更少的策略和导丝使用数,更短的导丝操控时间,而院内MACCE和并发症发生率无差异。

Objectives:To compare the application of antegrade dissection and re-entry(ADR)technique guided by Corsair microcatheter and CrossBoss catheter in the percutaneous coronary intervention(PCI)of chronic total occlusion(CTO)and validate the effectiveness and safety of Corsair microcatheter in establishing the subintimal track.Methods:141 consecutive patients who underwent CTO PCI utilizing ADR technique guided by Corsair microcatheter(Corsair group)or CrossBoss catheter(CrossBoss group)in the Department of Cardiology of the First Hospital Affiliated to Air Force Military Medical University from April 2016 to December 2020 were enrolled,and a total of 144 CTO PCI were included in this cohort.Clinical information including clinical characteristics,target lesion characteristics,CTO PCI outcomes,in-hospital major adverse cardiovascular and cerebrovascular events(MACCE)and complications were recorded.The differences in technical success rate of ADR,guidewire manipulation time,PCI time,number of strategies and guidewires used,contrast volume,and incidences of in-hospital MACCE and complications were compared between the two groups.Results:There were 72 CTO PCI in the Corsair group and 72 CTO PCI in the CrossBoss group.Technical success rate(94.4%vs.77.8%,P=0.004)and ADR success rate(83.3%vs.66.7%,P=0.021)were significantly higher in the Corsair group than in the CrossBoss group,while strategies(2.0±0.6 vs.2.2±0.7,P=0.017),number of guidewires(7±3 vs.9±3,P<0.001)and guidewire manipulation time(71[48,103]min vs.85[57,139]min,P=0.027)consumed were significantly reduced in the Corsair group compared with the CrossBoss group.No significant difference existed between the two groups in PCI time(146[114,193]min vs.148[94,192]min,P=0.644)and contrast volume(445[370,535]ml vs.415[320,518]ml,P=0.313).The in-hospital MACCE rate was 4.2%(6/144),incidence of perforation related to ADR was 2.1%(3/144),and side branch loss rate was 3.5%(5/144),and no statistical difference excisted in these incidences between the two groups.Conclusions:As compared with CrossBoss catheter,CTO PCI with ADR guided by Corsair microcatheter performed by experienced operators are associated with a higher success rate,fewer strategies and guidewires,and shorter guidewire manipulation time,but there is no significant difference in occurrence of in-hospital MACCE and complications between the two groups.