Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow cha...Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow characteristics.In“true”CTO,there is no anterograde flow.In“functional”CTO,there is minimal anterograde flow through the occluded segment of the coronary artery.CTO is a common fi nding during coronary angiography and its prevalence may vary depending on the reported literature.Among patients without previous coronary artery bypass grafting(CABG),CTO is found in about 20–30% of the patients.CTO may develop insidiously over a period of time and involve a complex interplay between intracellular and extracellular factors,smooth muscle and foam cells,calcifi cation,and neovascularization.There is a growing body of evidence to support that CTO revascularization may improve clinical outcome when compared to medical management.Both the European and American cardiovascular societies support CTO revascularization with a class 2a recommendation(level of evidence B).Historically,due to low procedural success rate,apparent ineffi cient resource utilization,potential increase in complication rates and uncertain clinical benefi ts,only about 10–20%of patients with CTO are treated with percutaneous coronary intervention(PCI).Recent advances using novel and innovative techniques with dedicated equipment have signifi cantly improved the procedural success rate for CTO PCI to about 90%in the hands of experienced operators.With increasing interest in CTO PCI coupled with increased educational effort,CTO PCI likely will become more accessible to patients in need of CTO revascularization.Ongoing advancement in innovative techniques and equipment will continue to improve procedural success rates and reduce procedural complication rate for CTO PCI.Furthermore,there are a number of prospective clinical trials on the horizon which should help defi ne the clinical benefi ts and limitations of CTO PCI in the near future.展开更多
Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years lea...Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.展开更多
Dear Editor： Chronic total occlusions （CTOs） of the coronary artery are commonly encountered complex lesionst11. Percutaneous coronary intervention （PCI） for CTO is technically challenging due to low procedural ...Dear Editor： Chronic total occlusions （CTOs） of the coronary artery are commonly encountered complex lesionst11. Percutaneous coronary intervention （PCI） for CTO is technically challenging due to low procedural success ratesTM. Microcatheter is one of the important devices for treatment of CTOTM. It has been widely used attributed to the excellent crossability whenever angula- tion and tortuousity of the coronary artery is encoun- tered. In the process, the microcatheter has to be withdrawn from the guide wire after the wire is proved to locate in the true lumen.展开更多
BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique h...BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.展开更多
Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year ...Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting （CABG） support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events （MACE）, defined as cardiac death, myocardial infarction and target-vessel revascularization （TVR）. Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients （86.8%）. Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths （（42.32±22.08） mm vs （27.61±22.85） mm, P=0.023）, a higher rate of perforation （25.0% vs 0, P=0.014）, and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure （10.0%, 30.0% and 35.0%） and the success （3.0%, 12.1% and 14.4%） groups （P=0.037, 0.034 and 0.040, respectively）. These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group （P=0.031 and 0.023, respectively）. Stump was the only predictor of recanalization success （HR 0.158, 95% Cl 0.041-0.612, P=0.008）, whereas procedural failure （OR 13.023, 95% CI 6.67-13.69, P=0.002）, incomplete revascularization （OR 9.71, 95% CI 2.93-5.59, P=0.005）, and total stent length （OR 6.02, 95% Cl 1.55-11.93, P=0.027） were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.展开更多
Objectives:Reported data regarding the prevalence,prognostic impact,and safety and efficacy of revascularization of coronary chronic total occlusion(CTO)in patients with left main coronary artery(LMCA)disease who unde...Objectives:Reported data regarding the prevalence,prognostic impact,and safety and efficacy of revascularization of coronary chronic total occlusion(CTO)in patients with left main coronary artery(LMCA)disease who undergo percutaneous coronary intervention(PCI)are scarce.The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI.Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures.Methods:All consecutive patients with significant LMCA disease(>50%stenosis at coronary angiography)who underwent PCI between July 2014 and December 2018 were retrospectively included in our study.The primary endpoint of the study was long-term mortality.Secondary endpoints included the incidence of myocardial infarction,repeat percutaneous or surgical revascularization,stroke,and stent thrombosis.Results:Between July 2014 and December 2018,578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled.They were divided into 3 groups:group A:374(65%)patients without CTO,group B:108(19%)patients with untreated or unsuccessfully treated CTO,and group C:96(17%)patients with successfully treated CTO.At a median follow-up of(1090±279)days,there were no statistically significant differences between the groups in terms of the primary and secondary endpoints.However,there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO(13%vs.19%vs.14%in groups A,B,and C,respectively;P=0.12).The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability:subgroup C1:54(56%)patients with successful percutaneous transluminal coronary angioplasty(PTCA)having viability,and subgroup C2:42(44%)patients with successful PTCA not having viability.There was a trend toward a statistically significant higher rate of death among patients in group B,who underwent unsuccessful recanalization with viable myocardium(19%vs.9%vs.19%in groups B,C1,and C2,respectively,P=0.05).On multivariable analysis,the propensity for successful revascularization of CTO was associated with a reduced risk of death(P=0.01;odds ratio,0.75;95%confidence interval:0.62-0.87).Conclusions:Among patients with LMCA disease undergoing PCI,CTO represents a common finding associated with worse prognosis.Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.展开更多
BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronical...BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.展开更多
目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者...目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者,按治疗方法分为两组,分别为常规组和观察组,每组30例。常规组给予常规治疗和替格瑞洛治疗,观察组在常规组基础上给予麝香保心丸治疗。比较两组治疗前和治疗12个月后血管炎症指数、血管内皮损伤和增殖标志物水平的变化,记录两组内皮舒张功能和侧支循环改善率。结果治疗前两组冠状动脉CTO患者的血管炎症指标、血管内皮损伤和增殖标志物比较差异均无统计学意义(P>0.05)。治疗后,观察组可溶性CD40配体(sCD40L)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、血管性血友病因子(vWF)显著下降,与常规组相比,差异具有统计学意义(P<0.05);而内皮一氧化氮合酶(eNOS)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和Jagged1蛋白均显著升高,与常规组相比,差异具有统计学意义(P<0.05);两组冠状动脉CTO患者的内皮舒张功能比较差异无统计学意义(P>0.05);观察组侧支循环良好率高于常规组(P<0.05)。结论替格瑞洛联合麝香保心丸治疗冠状动脉CTO患者可抑制血管炎症的表达,纠正其内皮功能障碍,促进内皮细胞增殖,改善冠状动脉CTO患者冠状动脉侧支循环。展开更多
Background The patients with unprotected left main coronary artery （ULMCA） stenosis and chronic total occlusion （CTO） lesions at the left anterior descending （LAD） artery are often recommended for bypass surgery...Background The patients with unprotected left main coronary artery （ULMCA） stenosis and chronic total occlusion （CTO） lesions at the left anterior descending （LAD） artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO. Methods From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients （7.7%） refused surgery due to their young age （S40 years）, and the other 72 patients （92.3%） were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age （〉80 years）, chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE ≥6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex. Results Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients （6.4%） experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up （（52±28） months）, there were 3 cardiac deaths （3.8%） and 4 （5.1%） nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients （64.1%）, and target vessel revascularizations were required in 10 patients （12.8%）, among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% （13/78）.Conclusions This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.展开更多
文摘Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow characteristics.In“true”CTO,there is no anterograde flow.In“functional”CTO,there is minimal anterograde flow through the occluded segment of the coronary artery.CTO is a common fi nding during coronary angiography and its prevalence may vary depending on the reported literature.Among patients without previous coronary artery bypass grafting(CABG),CTO is found in about 20–30% of the patients.CTO may develop insidiously over a period of time and involve a complex interplay between intracellular and extracellular factors,smooth muscle and foam cells,calcifi cation,and neovascularization.There is a growing body of evidence to support that CTO revascularization may improve clinical outcome when compared to medical management.Both the European and American cardiovascular societies support CTO revascularization with a class 2a recommendation(level of evidence B).Historically,due to low procedural success rate,apparent ineffi cient resource utilization,potential increase in complication rates and uncertain clinical benefi ts,only about 10–20%of patients with CTO are treated with percutaneous coronary intervention(PCI).Recent advances using novel and innovative techniques with dedicated equipment have signifi cantly improved the procedural success rate for CTO PCI to about 90%in the hands of experienced operators.With increasing interest in CTO PCI coupled with increased educational effort,CTO PCI likely will become more accessible to patients in need of CTO revascularization.Ongoing advancement in innovative techniques and equipment will continue to improve procedural success rates and reduce procedural complication rate for CTO PCI.Furthermore,there are a number of prospective clinical trials on the horizon which should help defi ne the clinical benefi ts and limitations of CTO PCI in the near future.
文摘Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.
文摘Dear Editor： Chronic total occlusions （CTOs） of the coronary artery are commonly encountered complex lesionst11. Percutaneous coronary intervention （PCI） for CTO is technically challenging due to low procedural success ratesTM. Microcatheter is one of the important devices for treatment of CTOTM. It has been widely used attributed to the excellent crossability whenever angula- tion and tortuousity of the coronary artery is encoun- tered. In the process, the microcatheter has to be withdrawn from the guide wire after the wire is proved to locate in the true lumen.
文摘BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.
文摘Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting （CABG） support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events （MACE）, defined as cardiac death, myocardial infarction and target-vessel revascularization （TVR）. Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients （86.8%）. Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths （（42.32±22.08） mm vs （27.61±22.85） mm, P=0.023）, a higher rate of perforation （25.0% vs 0, P=0.014）, and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure （10.0%, 30.0% and 35.0%） and the success （3.0%, 12.1% and 14.4%） groups （P=0.037, 0.034 and 0.040, respectively）. These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group （P=0.031 and 0.023, respectively）. Stump was the only predictor of recanalization success （HR 0.158, 95% Cl 0.041-0.612, P=0.008）, whereas procedural failure （OR 13.023, 95% CI 6.67-13.69, P=0.002）, incomplete revascularization （OR 9.71, 95% CI 2.93-5.59, P=0.005）, and total stent length （OR 6.02, 95% Cl 1.55-11.93, P=0.027） were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.
文摘Objectives:Reported data regarding the prevalence,prognostic impact,and safety and efficacy of revascularization of coronary chronic total occlusion(CTO)in patients with left main coronary artery(LMCA)disease who undergo percutaneous coronary intervention(PCI)are scarce.The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI.Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures.Methods:All consecutive patients with significant LMCA disease(>50%stenosis at coronary angiography)who underwent PCI between July 2014 and December 2018 were retrospectively included in our study.The primary endpoint of the study was long-term mortality.Secondary endpoints included the incidence of myocardial infarction,repeat percutaneous or surgical revascularization,stroke,and stent thrombosis.Results:Between July 2014 and December 2018,578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled.They were divided into 3 groups:group A:374(65%)patients without CTO,group B:108(19%)patients with untreated or unsuccessfully treated CTO,and group C:96(17%)patients with successfully treated CTO.At a median follow-up of(1090±279)days,there were no statistically significant differences between the groups in terms of the primary and secondary endpoints.However,there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO(13%vs.19%vs.14%in groups A,B,and C,respectively;P=0.12).The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability:subgroup C1:54(56%)patients with successful percutaneous transluminal coronary angioplasty(PTCA)having viability,and subgroup C2:42(44%)patients with successful PTCA not having viability.There was a trend toward a statistically significant higher rate of death among patients in group B,who underwent unsuccessful recanalization with viable myocardium(19%vs.9%vs.19%in groups B,C1,and C2,respectively,P=0.05).On multivariable analysis,the propensity for successful revascularization of CTO was associated with a reduced risk of death(P=0.01;odds ratio,0.75;95%confidence interval:0.62-0.87).Conclusions:Among patients with LMCA disease undergoing PCI,CTO represents a common finding associated with worse prognosis.Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.
文摘BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.
文摘目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者,按治疗方法分为两组,分别为常规组和观察组,每组30例。常规组给予常规治疗和替格瑞洛治疗,观察组在常规组基础上给予麝香保心丸治疗。比较两组治疗前和治疗12个月后血管炎症指数、血管内皮损伤和增殖标志物水平的变化,记录两组内皮舒张功能和侧支循环改善率。结果治疗前两组冠状动脉CTO患者的血管炎症指标、血管内皮损伤和增殖标志物比较差异均无统计学意义(P>0.05)。治疗后,观察组可溶性CD40配体(sCD40L)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、血管性血友病因子(vWF)显著下降,与常规组相比,差异具有统计学意义(P<0.05);而内皮一氧化氮合酶(eNOS)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和Jagged1蛋白均显著升高,与常规组相比,差异具有统计学意义(P<0.05);两组冠状动脉CTO患者的内皮舒张功能比较差异无统计学意义(P>0.05);观察组侧支循环良好率高于常规组(P<0.05)。结论替格瑞洛联合麝香保心丸治疗冠状动脉CTO患者可抑制血管炎症的表达,纠正其内皮功能障碍,促进内皮细胞增殖,改善冠状动脉CTO患者冠状动脉侧支循环。
文摘Background The patients with unprotected left main coronary artery （ULMCA） stenosis and chronic total occlusion （CTO） lesions at the left anterior descending （LAD） artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO. Methods From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients （7.7%） refused surgery due to their young age （S40 years）, and the other 72 patients （92.3%） were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age （〉80 years）, chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE ≥6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex. Results Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients （6.4%） experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up （（52±28） months）, there were 3 cardiac deaths （3.8%） and 4 （5.1%） nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients （64.1%）, and target vessel revascularizations were required in 10 patients （12.8%）, among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% （13/78）.Conclusions This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.
