水动力对比再通术（HDR）：描述一种治疗冠状动脉慢性全闭塞的新交叉技术。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-26 DOI:10.1002/ccd.31243

Mauro Carlino MD, Angelo Nascimbene MD, Emmanouil S. Brilakis MD, PhD, Akshitha Yarrabothula MD, Antonio Colombo MD, Sunao Nakamura MD, Lorenzo Azzalini MD, PhD, MSc, Bashir Hanif MD, M. Bilal Iqbal MD, PhD, Salman A. Arain MD

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引用次数: 0

摘要

背景：在慢性全闭塞（CTO）的经皮冠状动脉介入治疗（PCI）过程中，斑块内注射造影剂一直被用来划分解剖结构和促进导线穿越。目的：我们介绍了一种利用斑块内注射造影剂的诊断和治疗作用来完成 CTO 初级穿越的新技术：方法：HDR 是一种基于造影剂微注射和聚合物护套线协同作用的冠状动脉 CTO 前向穿越方法。方法：HDR 是一种逆行穿越冠状动脉 CTO 的方法，它是在造影剂微注射和聚合物护套线的协同作用下进行的。我们展示了一个回顾性、首例应用 HDR 进行 CTO PCI 的病例系列，患者均具有良好的 CTO 解剖结构（可见的近端部分和可识别的远端目标）。主要结果是手术成功。次要结果是手术并发症：共有 43 名患者的 45 个 CTO 接受了采用 HDR 的 CTO PCI。患者平均年龄为 64.3 ± 11 岁。日本 CTO 和 PROGRESS CTO 平均评分分别为 2.3 ± 0.7 和 1.8 ± 0.7。CTO 复杂性较高，34 例闭塞（76%）中有模糊或钝帽，27 例闭塞（60%）中病变长度≥ 20 毫米，36 例闭塞（80%）中度/重度钙化。使用 HDR 的手术成功率为 100%。无并发症：这项研究显示了 HDR 在 CTO PCI 中的实用性。HDR似乎是一种安全且有前景的新造影剂一次穿越技术，适用于特定患者。这一策略值得在更大规模的前瞻性研究中进一步评估。

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HydroDynamic contrast Recanalization (HDR): Description of a new crossing technique for coronary chronic total occlusions

Background

Intraplaque delivery of contrast has been utilized during percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) to delineate anatomy and to facilitate wire crossing. Its utility as a tool to accomplish primary crossing of CTOs has not been described or validated.

Aims

We describe a new technique leveraging the diagnostic and therapeutic roles of intraplaque contrast injection to accomplish primary crossing of CTOs: HydroDynamic contrast Recanalization (HDR).

Methods

HDR is an antegrade crossing method for coronary CTOs based on the synergistic use of contrast microinjections and polymer jacketed wires. We present a retrospective, first-in-man, case series utilizing HDR for CTO PCI in patients with favorable CTO anatomy (visible proximal segment and identifiable distal target). The primary outcome was procedural success. The secondary outcome was any procedural complications.

Results

A total of 43 patients with 45 CTOs underwent CTO PCI with HDR. Mean patient age was 64.3 ± 11 years. The mean Japanese CTO and PROGRESS CTO scores were 2.3 ± 0.7 and 1.8 ± 0.7, respectively. CTO complexity was high, with an ambiguous or blunt cap in 34 occlusions (76%); lesion length ≥ 20 mm in 27 occlusions (60%); and moderate/heavy calcification in 36 occlusions (80%). Procedural success using HDR was 100%. There were no complications.

Conclusions

This study shows the utility of HDR in CTO PCI. HDR appears to be a safe and promising new contrast-based primary crossing technique in selected patients. This strategy warrants further evaluation in larger prospective studies.

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.