Background The Guidezilla reverse controlled antegrade and retrograde tracking("Guidezilla reverse CART")technique has become one of guidewire crossing techniques in current retrograde coronary total occlusi...Background The Guidezilla reverse controlled antegrade and retrograde tracking("Guidezilla reverse CART")technique has become one of guidewire crossing techniques in current retrograde coronary total occlusion(CTO)percutaneous coronary intervention(PCI),but has received limited study regarding long-term outcomes.Our aim is to investigate procedural and long-term outcomes in a real-world cohort of CTO patients who underwent retrograde PCI with the"Guidezilla reverse CART"technique.Methods Our study included 315 patients who underwent retrograde CTO PCI,with 86 patients treated with"Guidezilla reverse CART"technique(the Guidezilla group)at Guangdong Cardiovascular Institute from January 2015 to December 2017.The median follow-up was 1.9 years.Major adverse cardiac events(MACE)were analyzed using the Kaplan-Meier method,and independent predictors of long-term MACE were determined using a multivariable Cox model.Results Procedural success of the Guidezilla group and non-Guidezilla group were 95.3%and 82.1%,respectively(P=0.003).The procedural complications and in-hospital MACE were similar between both groups.During the 4-year follow-up,27 patients had MACE.Multivariable analysis revealed that the"Guidezilla reverse CART"technique was not associated with worse long-term clinical outcomes[hazard ratio(HR):2.11;95%CI:0.64-6.98,P=0.220].Conclusions The"Guidezilla reverse CART"technique improves the success rate in retrograde PCI of more complex CTOs and is associated with similar complication and in-hospital MACE rates.The"Guidezilla reverse CART"technique is not significantly associated with adverse clinical outcomes.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
基金supported by Science and Technology Planning Project of Guangdong Province(No.2016A020216022)。
文摘Background The Guidezilla reverse controlled antegrade and retrograde tracking("Guidezilla reverse CART")technique has become one of guidewire crossing techniques in current retrograde coronary total occlusion(CTO)percutaneous coronary intervention(PCI),but has received limited study regarding long-term outcomes.Our aim is to investigate procedural and long-term outcomes in a real-world cohort of CTO patients who underwent retrograde PCI with the"Guidezilla reverse CART"technique.Methods Our study included 315 patients who underwent retrograde CTO PCI,with 86 patients treated with"Guidezilla reverse CART"technique(the Guidezilla group)at Guangdong Cardiovascular Institute from January 2015 to December 2017.The median follow-up was 1.9 years.Major adverse cardiac events(MACE)were analyzed using the Kaplan-Meier method,and independent predictors of long-term MACE were determined using a multivariable Cox model.Results Procedural success of the Guidezilla group and non-Guidezilla group were 95.3%and 82.1%,respectively(P=0.003).The procedural complications and in-hospital MACE were similar between both groups.During the 4-year follow-up,27 patients had MACE.Multivariable analysis revealed that the"Guidezilla reverse CART"technique was not associated with worse long-term clinical outcomes[hazard ratio(HR):2.11;95%CI:0.64-6.98,P=0.220].Conclusions The"Guidezilla reverse CART"technique improves the success rate in retrograde PCI of more complex CTOs and is associated with similar complication and in-hospital MACE rates.The"Guidezilla reverse CART"technique is not significantly associated with adverse clinical outcomes.
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.
