冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）是指闭塞时间≥3个月的血管病变,约占冠状动脉造影检出病变的13％～18％[1-2],尽管近年来在CTO的病理生理基础研究、治疗专用器械和经皮冠状动脉介入治疗（PCI）手术技巧等方...冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）是指闭塞时间≥3个月的血管病变,约占冠状动脉造影检出病变的13％～18％[1-2],尽管近年来在CTO的病理生理基础研究、治疗专用器械和经皮冠状动脉介入治疗（PCI）手术技巧等方面取得了很大的进展,但是CTO介入治疗的成功率仍然只有70％～80％[3-4].其中,80％的手术失败是因为导丝不能通过闭塞病变,约15％～20％的患者因球囊不能通过或支架不能很好扩张而失败.目前,关于球囊不能通过的闭塞病变介入手术方法,国内外相关文献报道较少.本文对在广东省人民医院心内科二病区13例球囊不能通过的CTO患者行冠状动脉腔内旋磨术进行了总结报道.展开更多
目的探讨Guidezilla^(TM)延长导管在冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)行逆向经皮冠状动脉介入治疗时协助导丝通过闭塞病变与导丝体外化的可行性以及安全性。方法回顾性分析广东省人民医院119例CTO患者。其中,2015...目的探讨Guidezilla^(TM)延长导管在冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)行逆向经皮冠状动脉介入治疗时协助导丝通过闭塞病变与导丝体外化的可行性以及安全性。方法回顾性分析广东省人民医院119例CTO患者。其中,2015年1月至2015年10月入选80例未使用Guidezilla^(TM)延长导管的反向控制性前向与逆向内膜下寻径(controlled anterograde and retrograde sub-intimal tracking,CART)技术的患者(Non-Guidezilla组),2015年10月至2016年11月入选39例使用Guidezilla^(TM)延长导管的反向CART技术的患者(Guidezilla组)。结果本研究中反向CART技术总体成功率为84.0%(100/119)。Guidezilla组成功率(100%比76.2%,P<0.05)高于Non-Guidezilla组,差异有统计学意义;两组患者平均J-CTO评分为2.67,Guidezilla组手术困难(35.9%比15.0%,P<0.001)和非常困难(61.5%比32.5%,P<0.001)的患者比例均高于Non-Guidezilla组,差异均有统计学意义;Guidezilla组二次手术率(25.6%比63.8%,P<0.001)及开口/分叉病变比例(30.8%比62.5%,P=0.002)均低于Non-Guidezilla组,差异均有统计学意义;Guidezilla组闭塞近段刀割状(53.8%比32.5%,P=0.030)、闭塞段长度>20 mm(89.7%比72.5%,P=0.035)及闭塞段弯曲>45°(84.6%比63.8%,P=0.020)的比例均高于Non-Guidezilla组,差异均有统计学意义。结论对于长迂曲的复杂CTO患者,逆向导丝与微导管难以通过病变并进入正向指引时,Guidezilla^(TM)延长导管能提供安全有效的解决方案。展开更多
经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)作为目前最常用的冠心病血运重建方式之一,其术中冠状动脉穿孔的发生率为0.27%~0.48%[1-2]。在对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变的治疗中,与正...经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)作为目前最常用的冠心病血运重建方式之一,其术中冠状动脉穿孔的发生率为0.27%~0.48%[1-2]。在对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变的治疗中,与正向介入技术相比,逆向介入技术治疗操作更复杂,并发症发生率更高。一项包括26个经逆向CTO-PCI的研究,纳入3482例CTO病变患者,相关荟萃分析结果显示侧支血管穿孔发生率6.9%,冠状动脉穿孔发生率4.3%,经心外膜侧支逆向PCI穿孔风险更大[3]。使用弹簧圈封堵是处理穿孔的常用方法,但是某些情况弹簧圈没有精确到位,甚至尾端残留在主干导致血管闭塞,后果严重,使用常规方法又因位置太远抓捕器无法到位。本文采用自创新方法回收弹簧圈,现报道如下。展开更多
Background Data on retrograde recanalization of epicardial collateral channels in patients with chronic total occlusion(CTO) undergoing percutaneous coronary intervention(PCI) are limited. Fearing about the complicati...Background Data on retrograde recanalization of epicardial collateral channels in patients with chronic total occlusion(CTO) undergoing percutaneous coronary intervention(PCI) are limited. Fearing about the complications of perforation, few CTO patients have chosen retrograde recanalization of epicardial collateral channels. Methods A retrospective analysis was conducted in this study. We followed up eligible patients who underwent continuous CTO via epicardial CCS from August 2011 to October 2018 in our center, and analyzed the detailed clinical baseline and angiographic data, surgical success rate and hospital complications to determine the efficacy and safety. The Cox model was used to compare major adverse cardiac events(MACE) and related co-variables between CTO patients with epicardial CCS perforation and non-perforated PCI patients. Results The study enrolled 191 patients with epicardial CCs PCI of CTO and the long term follow-up time was 24.03±19.18 months.Successful CCs PCI of CTO was achieved in 161(84.8 %) patients. Procedural collateral perforation occurred in23(12.0%) patients. MACEs occurred in 18 patients(9.4%) at 1-year follow-up. Kaplan-Meier curves showed no significant difference in MACEs between perforating recanalization of CCs PCI of CTO and non-perforating PCI of CTO.( adjusted hazard ratios(HR): 0.467; 95% confidence intervals(CI): 0.13 to 1.69, P=0.245). The multivariate Cox regression analysis identified the Werner score=0/1(HR: 5.80; 95% CI: 1.89 to 17.8; P=0.002) as significant independent predictors of perforation of CCs PCI of CTO. Conclusions The major complication of the procedure is collateral perforation. Recanalization of CTOs through epicardial collateral channel is safe and effective. It may be a available choice for recanalization of complex CTO.[S Chin J Cardiol 2019;20(1):37-43]展开更多
Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains u...Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.[S Chin J Cardiol 2019;20(3):168-173]展开更多
Background It was controversial that deferred stenting strategy could reduce no-reflow phenomena or major adverse cardiovascular events(MACEs)in primary percutaneous coronary intervention(PCI)for patients with STsegme...Background It was controversial that deferred stenting strategy could reduce no-reflow phenomena or major adverse cardiovascular events(MACEs)in primary percutaneous coronary intervention(PCI)for patients with STsegment elevation myocardial infarction(STEMI).Methods A total of 513 STEMI patients with high thrombus burden were retrospectively enrolled from January 2015 to January 2020.These patients were divided into two groups:experimental(with deferred stent implantation strategy,n=118)and control group(with immediate stenting strategy,n=395).The primary endpoint of this study was the incidence of no-reflow events.The secondly endpoints the in-hospital MACEs and one-year follow-up.Results The baseline characteristics were compared between the two groups.The occurrence of no-reflow phenomenon was significantly lower in the experiment group than the control group(16.9%vs.23.8%,P=0.035),which was mainly driven by the slow-flow(13.5%in experiment group vs.17.2%in control group,P=0.041).No significant difference was found between two groups in terms of in-hospital adverse events.The experiment group was associated with lower MACE rate than the control group(8.5%vs.15.7%,P=0.013)at one-year follow-up.Conclusions Deferred stenting had potential effect to reduce the risk no-reflow phenomenon in STEMI patients with high thrombus burden.This method was relatively safe and was associated with better clinical outcome.展开更多
Background The use of collateral channels(CCs)in crossing the occlusion plays a pivotal role in the retrograde PCI approach,but the impact of septal collateral distal tip injection(DTI)on contemporary septal collatera...Background The use of collateral channels(CCs)in crossing the occlusion plays a pivotal role in the retrograde PCI approach,but the impact of septal collateral distal tip injection(DTI)on contemporary septal collateral channels(CCs)crossing is still unknown.Methods 264 chronic total occlusion(CTO)cases in which the retrograde approach via septal collateral channels were enrolled after reviewing the coronary angiograms of 1300 patients from Jan 2014 to Dec 2019.This study collected the clinical and angiography data of those patents for analyzing the usefulness of this technology.In addition,a forward multivariable logistic-regression model was applied to identify the independent predictors of CC crossing failure.Results A total of 264 retrograde cases were divided into successful CCs crossing group(n=233,88.3%)and failure group(n=31,11.7%).Univariate statistics showed successful cases had low proportion of collateral channel tortuosity(42.1%vs.67.7%,P=0.011)and JCTO≥3 lesions(68.7%vs.90.3%,P=0.002)while had higher proportion of Werner CC2 collateral(52.8%vs.16.1%,P<0.001).Multivariate statistics found that the use of DTI was not significantly associated with increasing CCs crossing success rate.Twenty cases in success group performed DTI after CCs crossing failure.Conclusions Successful CTO PCI via septal CCs was not enhanced by the use of DTI before CCs attempt.展开更多
Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary interventio...Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]展开更多
Background Totally radial access(TRA) is getting popular in coronary chronic total occlusion(CTO) percutaneous coronary intervention(PCI). but it has been associated with a non-negligible risk of complications. Method...Background Totally radial access(TRA) is getting popular in coronary chronic total occlusion(CTO) percutaneous coronary intervention(PCI). but it has been associated with a non-negligible risk of complications. Methods This retrospective study included 1760 CTO patients underwent PCI from January 2015 to January 2018.Patients were divided into two groups: TRA group was referred to single radial or double radial access;Femoral access(FA) group was referred to single FA, double FA, FA and RA. The primary efficacy endpoint was procedural success, which was defined as technical success without in-hospital MACE. The primary safety endpoint was a composite of vascular complications and major bleeding. Results TRA was applied in 482 cases, while FA in 1278 cases. Mean J-CTO scores was higher in FA group(2.5±1.0 vs. 2.0±0.9, P=0.001). Procedural success showed no significant difference between both groups(82.9% vs. 83.6%, P=0.823). The primary safety endpoint was higher in FA group(11.4 vs. 4.1%, P<0.001). On multivariate analysis, FA approach was independently associated with the primary safety endpoint [odds ratio;(OR) 2.887, 95% confidence interval(CI) 1.759-4.739,P=0.001], after adjusting for age, diabetes, body mass index, prior CABG, and J-CTO score. Conclusions TRA for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, while maintaining similarly high success rates.[S Chin J Cardiol 2019;20(4):211-216]展开更多
Background The retrograde approach allows to significantly increase the success rate of coronary chronic total occlusion（CTO） percutaneous intervention（PCI）. Epicardial collateral channels（CCs） remain an essenti...Background The retrograde approach allows to significantly increase the success rate of coronary chronic total occlusion（CTO） percutaneous intervention（PCI）. Epicardial collateral channels（CCs） remain an essential channel for retro-recanalization. But paucity of data in this area limits the use of epicardial CCs for retrograde canalization. The present study was to explore the feasibility and significance of coronary epicardial collaterals for the retrograde approach treatment of coronary CTO. Methods We retrospectively analyzed 347 CTO cases which the retrograde approach was attempted after reviewing the coronary angiograms of 1290 patients. And there were 89 retrograde approach PCI cases applying epicardial CCs. We collected the clinical and angiography data of those patents for analyzing the safety and usefulness of this technology. Results The study consisted of347 CTO PCI. Mean age was 60.8±10.4 and 60.3±10.2 years in epicardial CCs and septal CCs groups respectively. The total retrograde success rate was 79.8%. The success rate of retrograde approach applying epicardial CCs was not lower（82.0% vs. 79.1%, P=0.646） than that in cases applying septal CCs. There were 8 epicardial CCs injury cases（9.0%） and 3 cases resulted in cardiac tamponade and required emergency pericardiocentesis. Coils were used for all of them with success. No patients were dead in retrograde approach applying epicardial CCS.Conclusions Coronary epicardial collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTO, which is relative feasible, and has a high success rate. Epicardial CCs injury can be safety as long as it is treated timely.展开更多
Background Septal Surfing Technology （SST） is one of the most important techniques for collateral channels （CCs） crossing in retrograde chronic total occlusion （CTO） of percutaneous coronary intervention （PCI）...Background Septal Surfing Technology （SST） is one of the most important techniques for collateral channels （CCs） crossing in retrograde chronic total occlusion （CTO） of percutaneous coronary intervention （PCI）. We ex- amined this technique＇ s usefulness in retrograde CTO-PCI cases. Methods We retrospective analyzed 728 con-secutive CTO-PCI cases from January 2014 to September 2016. One hundred and forty-two patients who had un- dergone retrograde PCIs using septal collateral channels （CCs） were collected. Univariate and multivariate analyses were conducted to identify independent predictors for SST CCs crossing success. Results The CCs crossing success rate was 89.4% during retrograde PCI. Three factors were figured out as independent predictors, includ- ing CCs tortuosity （OR 0.164, 95%CI： 0.041-0.657; P=0.011）, diameter of distal CTO lesion （2.035, 95%CI： 1.011-4.099; P=0.047） and LAD-CTO （OR 0.244, 95%CI：0.067-0.894; P=0.033）. There were complications of CCs injury in 23.2% cases and 2.1% cases had cardiac tamponade without any in-hospital death. Conclusion SST is an effective method in collateral crossing during retrograde CTO-PCI. It has high successful rate regard-less of the Werner Collateral Class of interventional collaterals, especially in invisible collaterals. This technolo- gy is feasible in daily practice of retrograde PCI.展开更多
文摘冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）是指闭塞时间≥3个月的血管病变,约占冠状动脉造影检出病变的13％～18％[1-2],尽管近年来在CTO的病理生理基础研究、治疗专用器械和经皮冠状动脉介入治疗（PCI）手术技巧等方面取得了很大的进展,但是CTO介入治疗的成功率仍然只有70％～80％[3-4].其中,80％的手术失败是因为导丝不能通过闭塞病变,约15％～20％的患者因球囊不能通过或支架不能很好扩张而失败.目前,关于球囊不能通过的闭塞病变介入手术方法,国内外相关文献报道较少.本文对在广东省人民医院心内科二病区13例球囊不能通过的CTO患者行冠状动脉腔内旋磨术进行了总结报道.
文摘目的探讨Guidezilla^(TM)延长导管在冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)行逆向经皮冠状动脉介入治疗时协助导丝通过闭塞病变与导丝体外化的可行性以及安全性。方法回顾性分析广东省人民医院119例CTO患者。其中,2015年1月至2015年10月入选80例未使用Guidezilla^(TM)延长导管的反向控制性前向与逆向内膜下寻径(controlled anterograde and retrograde sub-intimal tracking,CART)技术的患者(Non-Guidezilla组),2015年10月至2016年11月入选39例使用Guidezilla^(TM)延长导管的反向CART技术的患者(Guidezilla组)。结果本研究中反向CART技术总体成功率为84.0%(100/119)。Guidezilla组成功率(100%比76.2%,P<0.05)高于Non-Guidezilla组,差异有统计学意义;两组患者平均J-CTO评分为2.67,Guidezilla组手术困难(35.9%比15.0%,P<0.001)和非常困难(61.5%比32.5%,P<0.001)的患者比例均高于Non-Guidezilla组,差异均有统计学意义;Guidezilla组二次手术率(25.6%比63.8%,P<0.001)及开口/分叉病变比例(30.8%比62.5%,P=0.002)均低于Non-Guidezilla组,差异均有统计学意义;Guidezilla组闭塞近段刀割状(53.8%比32.5%,P=0.030)、闭塞段长度>20 mm(89.7%比72.5%,P=0.035)及闭塞段弯曲>45°(84.6%比63.8%,P=0.020)的比例均高于Non-Guidezilla组,差异均有统计学意义。结论对于长迂曲的复杂CTO患者,逆向导丝与微导管难以通过病变并进入正向指引时,Guidezilla^(TM)延长导管能提供安全有效的解决方案。
文摘经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)作为目前最常用的冠心病血运重建方式之一,其术中冠状动脉穿孔的发生率为0.27%~0.48%[1-2]。在对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变的治疗中,与正向介入技术相比,逆向介入技术治疗操作更复杂,并发症发生率更高。一项包括26个经逆向CTO-PCI的研究,纳入3482例CTO病变患者,相关荟萃分析结果显示侧支血管穿孔发生率6.9%,冠状动脉穿孔发生率4.3%,经心外膜侧支逆向PCI穿孔风险更大[3]。使用弹簧圈封堵是处理穿孔的常用方法,但是某些情况弹簧圈没有精确到位,甚至尾端残留在主干导致血管闭塞,后果严重,使用常规方法又因位置太远抓捕器无法到位。本文采用自创新方法回收弹簧圈,现报道如下。
基金supported by Science and Technology Planning Project of Guangdong Province(No.2016A020216022)
文摘Background Data on retrograde recanalization of epicardial collateral channels in patients with chronic total occlusion(CTO) undergoing percutaneous coronary intervention(PCI) are limited. Fearing about the complications of perforation, few CTO patients have chosen retrograde recanalization of epicardial collateral channels. Methods A retrospective analysis was conducted in this study. We followed up eligible patients who underwent continuous CTO via epicardial CCS from August 2011 to October 2018 in our center, and analyzed the detailed clinical baseline and angiographic data, surgical success rate and hospital complications to determine the efficacy and safety. The Cox model was used to compare major adverse cardiac events(MACE) and related co-variables between CTO patients with epicardial CCS perforation and non-perforated PCI patients. Results The study enrolled 191 patients with epicardial CCs PCI of CTO and the long term follow-up time was 24.03±19.18 months.Successful CCs PCI of CTO was achieved in 161(84.8 %) patients. Procedural collateral perforation occurred in23(12.0%) patients. MACEs occurred in 18 patients(9.4%) at 1-year follow-up. Kaplan-Meier curves showed no significant difference in MACEs between perforating recanalization of CCs PCI of CTO and non-perforating PCI of CTO.( adjusted hazard ratios(HR): 0.467; 95% confidence intervals(CI): 0.13 to 1.69, P=0.245). The multivariate Cox regression analysis identified the Werner score=0/1(HR: 5.80; 95% CI: 1.89 to 17.8; P=0.002) as significant independent predictors of perforation of CCs PCI of CTO. Conclusions The major complication of the procedure is collateral perforation. Recanalization of CTOs through epicardial collateral channel is safe and effective. It may be a available choice for recanalization of complex CTO.[S Chin J Cardiol 2019;20(1):37-43]
文摘Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.[S Chin J Cardiol 2019;20(3):168-173]
文摘Background It was controversial that deferred stenting strategy could reduce no-reflow phenomena or major adverse cardiovascular events(MACEs)in primary percutaneous coronary intervention(PCI)for patients with STsegment elevation myocardial infarction(STEMI).Methods A total of 513 STEMI patients with high thrombus burden were retrospectively enrolled from January 2015 to January 2020.These patients were divided into two groups:experimental(with deferred stent implantation strategy,n=118)and control group(with immediate stenting strategy,n=395).The primary endpoint of this study was the incidence of no-reflow events.The secondly endpoints the in-hospital MACEs and one-year follow-up.Results The baseline characteristics were compared between the two groups.The occurrence of no-reflow phenomenon was significantly lower in the experiment group than the control group(16.9%vs.23.8%,P=0.035),which was mainly driven by the slow-flow(13.5%in experiment group vs.17.2%in control group,P=0.041).No significant difference was found between two groups in terms of in-hospital adverse events.The experiment group was associated with lower MACE rate than the control group(8.5%vs.15.7%,P=0.013)at one-year follow-up.Conclusions Deferred stenting had potential effect to reduce the risk no-reflow phenomenon in STEMI patients with high thrombus burden.This method was relatively safe and was associated with better clinical outcome.
文摘Background The use of collateral channels(CCs)in crossing the occlusion plays a pivotal role in the retrograde PCI approach,but the impact of septal collateral distal tip injection(DTI)on contemporary septal collateral channels(CCs)crossing is still unknown.Methods 264 chronic total occlusion(CTO)cases in which the retrograde approach via septal collateral channels were enrolled after reviewing the coronary angiograms of 1300 patients from Jan 2014 to Dec 2019.This study collected the clinical and angiography data of those patents for analyzing the usefulness of this technology.In addition,a forward multivariable logistic-regression model was applied to identify the independent predictors of CC crossing failure.Results A total of 264 retrograde cases were divided into successful CCs crossing group(n=233,88.3%)and failure group(n=31,11.7%).Univariate statistics showed successful cases had low proportion of collateral channel tortuosity(42.1%vs.67.7%,P=0.011)and JCTO≥3 lesions(68.7%vs.90.3%,P=0.002)while had higher proportion of Werner CC2 collateral(52.8%vs.16.1%,P<0.001).Multivariate statistics found that the use of DTI was not significantly associated with increasing CCs crossing success rate.Twenty cases in success group performed DTI after CCs crossing failure.Conclusions Successful CTO PCI via septal CCs was not enhanced by the use of DTI before CCs attempt.
文摘Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]
基金supported by the Science and Technology Innovation Project from Foshan,Guangdong(No.FS0AA-KJ218-1301-0010)
文摘Background Totally radial access(TRA) is getting popular in coronary chronic total occlusion(CTO) percutaneous coronary intervention(PCI). but it has been associated with a non-negligible risk of complications. Methods This retrospective study included 1760 CTO patients underwent PCI from January 2015 to January 2018.Patients were divided into two groups: TRA group was referred to single radial or double radial access;Femoral access(FA) group was referred to single FA, double FA, FA and RA. The primary efficacy endpoint was procedural success, which was defined as technical success without in-hospital MACE. The primary safety endpoint was a composite of vascular complications and major bleeding. Results TRA was applied in 482 cases, while FA in 1278 cases. Mean J-CTO scores was higher in FA group(2.5±1.0 vs. 2.0±0.9, P=0.001). Procedural success showed no significant difference between both groups(82.9% vs. 83.6%, P=0.823). The primary safety endpoint was higher in FA group(11.4 vs. 4.1%, P<0.001). On multivariate analysis, FA approach was independently associated with the primary safety endpoint [odds ratio;(OR) 2.887, 95% confidence interval(CI) 1.759-4.739,P=0.001], after adjusting for age, diabetes, body mass index, prior CABG, and J-CTO score. Conclusions TRA for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, while maintaining similarly high success rates.[S Chin J Cardiol 2019;20(4):211-216]
基金supported by Science and Technology Planning Project of Guangdong Province(No.2016A020216022)
文摘Background The retrograde approach allows to significantly increase the success rate of coronary chronic total occlusion（CTO） percutaneous intervention（PCI）. Epicardial collateral channels（CCs） remain an essential channel for retro-recanalization. But paucity of data in this area limits the use of epicardial CCs for retrograde canalization. The present study was to explore the feasibility and significance of coronary epicardial collaterals for the retrograde approach treatment of coronary CTO. Methods We retrospectively analyzed 347 CTO cases which the retrograde approach was attempted after reviewing the coronary angiograms of 1290 patients. And there were 89 retrograde approach PCI cases applying epicardial CCs. We collected the clinical and angiography data of those patents for analyzing the safety and usefulness of this technology. Results The study consisted of347 CTO PCI. Mean age was 60.8±10.4 and 60.3±10.2 years in epicardial CCs and septal CCs groups respectively. The total retrograde success rate was 79.8%. The success rate of retrograde approach applying epicardial CCs was not lower（82.0% vs. 79.1%, P=0.646） than that in cases applying septal CCs. There were 8 epicardial CCs injury cases（9.0%） and 3 cases resulted in cardiac tamponade and required emergency pericardiocentesis. Coils were used for all of them with success. No patients were dead in retrograde approach applying epicardial CCS.Conclusions Coronary epicardial collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTO, which is relative feasible, and has a high success rate. Epicardial CCs injury can be safety as long as it is treated timely.
文摘Background Septal Surfing Technology （SST） is one of the most important techniques for collateral channels （CCs） crossing in retrograde chronic total occlusion （CTO） of percutaneous coronary intervention （PCI）. We ex- amined this technique＇ s usefulness in retrograde CTO-PCI cases. Methods We retrospective analyzed 728 con-secutive CTO-PCI cases from January 2014 to September 2016. One hundred and forty-two patients who had un- dergone retrograde PCIs using septal collateral channels （CCs） were collected. Univariate and multivariate analyses were conducted to identify independent predictors for SST CCs crossing success. Results The CCs crossing success rate was 89.4% during retrograde PCI. Three factors were figured out as independent predictors, includ- ing CCs tortuosity （OR 0.164, 95%CI： 0.041-0.657; P=0.011）, diameter of distal CTO lesion （2.035, 95%CI： 1.011-4.099; P=0.047） and LAD-CTO （OR 0.244, 95%CI：0.067-0.894; P=0.033）. There were complications of CCs injury in 23.2% cases and 2.1% cases had cardiac tamponade without any in-hospital death. Conclusion SST is an effective method in collateral crossing during retrograde CTO-PCI. It has high successful rate regard-less of the Werner Collateral Class of interventional collaterals, especially in invisible collaterals. This technolo- gy is feasible in daily practice of retrograde PCI.
