Comparison between tip-detection method and retrograde approach for chronic total occlusion percutaneous coronary intervention.

IF 3.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Toshikazu Kashiyama, Atsunori Okamura, Yasushi Koyama, Mustumi Iwamoto, Satoshi Watanabe, Akinori Sumiyoshi, Kota Tanaka, Heitaro Watanabe, Yasushi Sakata, Katsuomi Iwakura
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引用次数: 0

Abstract

Background: The tip-detection method and the retrograde approach have been acknowledged as a second-line strategies for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) when conventional antegrade wiring strategies are ineffective. The aim of this study is to compare the efficacy between both strategies for complex CTO PCI.

Methods: We retrospectively enrolled 170 consecutive CTO PCI cases and separated them into 295 adopted strategies. The rate of successful lesion crossing and its association with the time spent for each strategy were compared between the tip-detection method and the retrograde approach.

Results: We observed fifty-six attempts with the tip-detection methods with 46 (82.1%) successful lesion crossings. Sixty-one retrograde approaches were performed, in which 29 (47.5%) cases achieved procedural success. In the successful attempts, the wire-manipulation time was significantly shorter in the tip-detection method [20.0 (12.2-36.7) min] than the retrograde approach [35.0 (20.7-49.7) min] (p = 0.008). Cox-regression analysis showed time-dependent advantage for the tip-detection method over the retrograde approach [hazard ratio (HR) = 2.93, 95% CI = 1.84-4.67, p < 0.001]. Incomplete tip-detection CTO crossing (taking > 30 min) was seen in severely tortuous lesions [odds ratio 0.26, 95% confidence interval 0.06-0.97, p = 0.037].

Conclusion: The tip-detection method can reduce the wire-manipulation time for successful CTO PCI compared with the retrograde approach. However, the success rate of the tip-detection method is hampered by severe lesion tortuosity.

慢性全闭塞经皮冠状动脉介入治疗中尖端检测法与逆行法的比较
背景:当传统的前向布线策略无效时,尖端检测法和逆行方法被认为是慢性全闭塞(CTO)经皮冠状动脉介入治疗(PCI)的二线策略。本研究旨在比较两种策略在复杂 CTO PCI 中的疗效:我们回顾性地纳入了 170 例连续的 CTO PCI 病例,并将其分为 295 种采用的策略。比较了尖端检测法和逆行法的病变穿越成功率及其与每种策略所用时间的关系:结果:我们观察到采用尖端检测法进行了 56 次尝试,其中 46 次(82.1%)成功穿越病灶。进行了 61 次逆行入路,其中 29 例(47.5%)获得了手术成功。在成功的尝试中,尖端检测法的导线操作时间[20.0 (12.2-36.7) min]明显短于逆行法[35.0 (20.7-49.7) min](P = 0.008)。Cox回归分析显示,在严重迂曲的病变中,尖端检测法比逆行法具有时间依赖性优势[危险比(HR)= 2.93,95% CI = 1.84-4.67,p = 30分钟][几率比 0.26,95% 置信区间 0.06-0.97,p = 0.037]:结论:与逆行方法相比,尖端检测法可缩短成功进行 CTO PCI 的导线操作时间。结论:与逆行方法相比,尖端探测法可缩短成功进行 CTO PCI 的导线操作时间,但严重的病变迂曲会影响尖端探测法的成功率。
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来源期刊
Cardiovascular Intervention and Therapeutics
Cardiovascular Intervention and Therapeutics CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.30
自引率
12.50%
发文量
68
期刊介绍: Cardiovascular Intervention and Therapeutics (CVIT) is an international journal covering the field of cardiovascular disease and includes cardiac (coronary and noncoronary) and peripheral interventions and therapeutics. Articles are subject to peer review and complete editorial evaluation prior to any decision regarding acceptability. CVIT is an official journal of The Japanese Association of Cardiovascular Intervention and Therapeutics.
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