冠状动脉闭塞病变介入治疗的临床研究

目的：探讨冠状动脉闭塞经皮冠状动脉腔内成形术（PTCA）治疗的效果。方法：对23例行PTCA及支架置入患者进行临床分析。结果：23例患者PTCA及置入支架后24支闭塞血管18支被开通，血管病变开通成功率72．0％，病例成功率78．3％（18／23），闭塞病变时间〈3个月组的患者成功率92．3％，明显高于闭塞病变时间〉3个月组的患者54．5％（P〈0．01）。结论：冠状动脉完全闭塞病变患者行PTCA及置入支架治疗是安全可行的，血管闭塞的时间和病变局部形态特征是手术成功的重要因素。     

冠状动脉慢性完全闭塞病变治疗后远期心脏磁共振右心室心肌应变的初步分析

目的 旨在探讨心脏磁共振（cardiac magnetic resonance,CMR）心肌应变（myocardial strain,MS）用于定量分析冠状动脉慢性完全闭塞（chronic total occlusion,CTO）患者临床治疗后随访复查右心室（right ventricle,RV）的功能情况。方法 纳入于我院确诊为CTO、并于治疗前后两次均完成CMR扫描病人13例,复查时间范围259~1168天。采用CVI 42软件测量左右心室结构功能参数及RV MS参数,比较CMR复查前后各参数差异性。结果1、就左心室结构功能参数而言,CTO患者治疗前后数据均无明显统计学差异（P均＞0.05）。2、就右心室参数而言,RVEDV、RVESV较复查前明显增大（分别为144.52±25.14 vs 118.46±28.08 mL,P=0.02;71.51±14.59 vs 55.62±15.93 mL,P=0.014）,RVEF等及各应变、应变率均无明显统计学差异。结论CTO患者在经治疗随访500.08±228.34天后,RVEF及MS保持稳定,但可观察到RVEDV、RVESV增大改变。     

血小板分布宽度与慢性完全闭塞性冠状动脉病变的关系

目的：探讨血小板分布宽度（PDW）与慢性完全闭塞性冠状动脉病变（CTO）的关系。方法选取行冠状动脉造影的255例患者,将其分为冠状动脉正常组、冠心病非CTO组和CTO组,每组85例。比较3组患者的临床资料及血生化指标,采用多元logsitic回归分析冠心病患者发生CTO的危险因素,采用受试者工作特征（ ROC）曲线分析PDW预测CTO的敏感性及特异性。结果 CTO 组 PDW 水平明显高于其余两组（ P ＜0．05）。多因素 logistic 回归分析结果显示 PDW、WBC、Gensini积分是冠心病患者发生CTO的危险因素（P＜0．05）。 ROC曲线结果显示,PDW截点值为12．35时,PDW预测CTO的敏感性和特异性分别为73．0％和57．0％。 PDW与CTO组冠状动脉病变严重程度呈正相关（r＝0．946,P＜0．05）。结论 PDW与CTO有关,前者可独立预测CTO的发生及评估冠状动脉狭窄程度,并且具有较好的敏感性。     

经皮冠状动脉内介入治疗慢性完全闭塞病变影响因素探讨

目的:探讨慢性完全闭塞性病变(CTO)经皮冠状动脉介入(PCI)治疗的影响因素.方法:回顾2000年4月至2006年6月东南大学附属中大医院行PCI治疗的CTO患者48例,CTO病变共51处,记录患者临床特征、靶病变特点和靶病变PCI操作结果,行logistic逐步回归分析,筛选PCI成功的预测因素.结果:48例患者中33例36处成功,15例15处失败,病例成功率68.8%,靶病变成功率70.6%.2000年4月至2003年5月10例患者10处病变4例4处成功,病例及病变成功率均为40.0%;2003年6月至2006年6月38例患者41处病变中29例32处成功,成功率分别为76.3%,78.0%.2003年6月之后病变成功率较之前明显提高(P＜0.05).经logistic逐步回归分析,介入操作成功的预测因素为桥侧支缺如(P=0.001)、病变闭塞持续时间≤3个月(P=0.005)、功能性闭塞(P=0.005)、病变近端呈鼠尾状(P=0.026).结论:CTO介入治疗操作成功率除与术者经验和新型介入器材应用有关外,与病变特点密切相关,而与临床特点关系较小.在病变特点中,桥侧支缺如、病变闭塞持续时间≤3个月、功能性闭塞、病变近端呈鼠尾状是CTO行PCI操作成功的预测因素.     

慢性完全闭塞性病变介入治疗影响因素分析

目的：探讨经皮冠状动脉介入(PCI)治疗慢性完全闭塞性病变(CT0)介入治疗成功率的影响因素。方法：对本院2000年5月—2002年9月24例26处CT0的PCI资料进行回顾性分析。结果：24例26处CT0，总成功率达80．8％，支架置人19处(73．1％)。血管闭塞时间≤3个月、闭塞长度≤20mm、闭塞末端呈尖形者PCI成功率较高，有桥状侧支、闭塞近端血管重度弯曲者手术均失败。结论：影响成功率的因素有血管闭塞时间、闭塞长度、闭塞末端形态、桥状侧支、闭塞近端血管弯曲等。     

对侧造影在治疗冠状动脉慢性闭塞病变中的临床应用（附10例病例报告）

目的：评价冠状动脉慢性闭塞病变（CTO）患者介入治疗中,经对侧冠状动脉造影定位导丝方法的可行性及安全性。方法：10例经冠脉造影证实冠状动脉CTO,且病变远端有对侧冠状动脉侧枝循环形成。在导引导管及导丝到位后,穿刺桡动脉或左侧股动脉,在对侧冠状动脉放置造影导管,在操纵导丝通过病变处时借助桡动脉或左侧股动脉造影使靶血管远端显影,判断导丝是否在靶血管腔中。结果：8例成功经皮冠状动脉腔内成形术（PTCA）及支架置入术,2例失败,术中无冠状动脉夹层及穿孔等并发症发生。结论：经对侧血管造影,通过侧支循环使CTO远端显影,是判断导丝位置是否在靶血管腔内的安全而有效的途径,有助于提高CTO介入治疗成功率。     

Percutaneous coronary intervention for chronic total occlusion in 1263 patients: a single-center report

Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.     

Long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion

BackgroundThe development of the technique has improved the success rate of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). However, long-term outcomes remain unclear. The present study sought to investigate long-term outcomes of PCI for IS-CTO.MethodsA total of 474 IS-CTO patients were enrolled at two cardiac centers from 2015 to 2018 retrospectively. These patients were allocated into either successful or failed IS-CTO PCI groups. The primary endpoint (major adverse cardiac events [MACE]) consisted of recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) at follow-up. Multivariable Cox regression analysis was used to investigate the association between treatment appropriateness and clinical outcomes.ResultsA total of 367 patients were successfully treated with IS-CTO PCI while 107 patients had failed recanalization. After a median follow-up of 30 months (interquartile range: 17–42 months), no significant difference was observed between the two groups for the following parameters: cardiac death (successful PCI vs. failed PCI: 0.9% vs. 2.7%; adjusted hazard ratio [HR]: 1.442; 95% confidence interval [CI]: 0.21–9.887; P = 0.709), RAP (successful PCI vs. failed PCI: 40.8% vs. 40.0%; adjusted HR: 1.025; 95% CI: 0.683–1.538; P = 0.905), heart failure (successful PCI vs. failed PCI: 6.1% vs. 2.7%; adjusted HR: 0.281; 95% CI: 0.065–1.206; P = 0.088), target-vessel related MI (successful PCI vs. failed PCI: 1.5% vs. 2.7%; adjusted HR: 1.150; 95% CI: 0.221–5.995; P = 0.868), MACE (successful PCI vs. failed PCI: 44.2% vs. 45.3%; adjusted HR: 1.052; 95% CI: 0.717–1.543; P = 0.797). More patients were free of angina in the successful IS-CTO PCI group compared with failed PCI in the first (80.4% vs. 60%, P < 0.01) and second years (73.3% vs. 60.0%, P = 0.02) following up. Successful IS-CTO PCI had a lower incidence of MACE in the first and second years (20.2% vs. 40.0%, P < 0.01; 27.9% vs. 41.3%, P = 0.023) compared with failed PCI. After a median follow-up of 30 months, the reocclusion rate was 28.5% and TVR was 26.1% in the successful IS-CTO PCI group. Receiving >18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of TVR (HR: 2.682; 95% CI: 1.295–5.578; P = 0.008) or MACE (without TVR) (HR: 1.898; 95% CI: 1.036–3.479; P = 0.038) in successful IS-CTO PCI.ConclusionsAfter a median follow-up of 30 months, the successful IS-CTO PCI group had MACE similar to that of the failed PCI group. However, the successful IS-CTO PCI group had improved angina symptoms and were free from requiring coronary artery bypass grafting in the first or second years. To decrease MACE, DAPT was found to be essential and recommended for at least 18 months for IS-CTO PCI.     

介入治疗冠脉完全闭塞病变影响因素的分析

目的评价冠状动脉（冠脉）慢性完全闭塞病变（CTO）特点对经皮冠状动脉介入治疗（PCI）的影响。方法对300例CTO患者的临床资料、病变特征和PCI结果进行回顾性分析。结果闭塞病变类型为功能性及绝对性、长度≤15mm和〉15mm、有开口和无开口及断端为鼠尾状和刀切状,以上各组内PCI成功率分别为90．1％和76．3％、85．2％和72．1％、88．3％和80％、84．2％和55％（P〈0．05）;闭塞病变的位置、闭塞时间、有无桥血管、有无分支发出、有无钙化、远端有无显影及血管有无迂曲各组内差异无统计学意义（P〉0．05）。结论闭塞病变类型、长度、有无开口及断端的形状是成功PCI的影响因素。     

冠状动脉完全闭塞的介入治疗

目的　探讨应用经皮冠状动脉成形术 (PTCA)及支架植入术治疗冠状动脉完全闭塞病变的成功率和疗效。方法　 48例冠状动脉完全闭塞的患者 ,造影显示单支病变 2 9例 ,双支病变 14例 ,三支病变 5例 ;完全闭塞的病变中 ,前降支 2 7支 ,回旋支 4支 ,右冠状动脉 17支。先对完全闭塞病变进行PTCA ,而后根据情况植入冠状动脉内支架。结果　 48例完全闭塞病变扩张成功 43例 ,成功率 89.6 %。扩张成功的 43例病变植入支架 40例 ,植入率为93%。 1例患者出现少量心包积血 ,其余病例术中及术后均无并发症。结论　冠状动脉内支架的植入有助于提高完全闭塞病变PTCA治疗的疗效 ,降低再狭窄率 ,具有较高的安全性     

Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

Background  In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.

Methods  From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.

Results  At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% CI 1.219–3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739–45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.

Conclusions  Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

     

Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral related complication

Background The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries.This study was ...     

冠心病介入治疗后再狭窄因素分析

目的　探讨冠心病介入治疗后再狭窄与冠心病易患因素关系。方法 冠心病介入治疗440例中,选择连续84例(n5个狭窄病变)术后随访冠脉造影复查者,冠脉定量分析(QCA)术前、术后和随访复查冠脉造影图象,并分析再狭窄与冠心病易患因素的关系。 结果 患者6个月再狭窄率为40.00%,多元回归分析再狭窄发生时间与吸烟史、多个易患因素、多支病变、病变类型和前降支病变呈正性相关,与支架置入呈负性相关。 结论 冠心病易患因素与介入后再狭窄发生有密切的关系,特别是吸烟史。     

Age-based clinical and angiographic outcomes after sirolimus-eluting stent implantation in patients with coronary artery disease

Background Advanced age independently predicts early and late mortality and major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI）. Randomized clinical trials indicate that siroUmus-eluting stent （SES） implantation reduces target lesion revascularization （TLR）, but there are limited data on the impact of age on outcomes following SES implantation in patients with coronary artery disease （CAD） in real-world practice. Methods A total of 333 CAD patients with 453 lesions were enrolled in this study. Subjects were divided into two groups according to age： a young group （〈65 years old, 244 patients with 369 lesions） and elderly group （≥65 years old, 89 patients with 113 lesions）. Clinical follow-up and quantitative coronary angiography （QCA） were performed seven months after PCh Results Baseline clinical, demographic, angiographic, and procedural chararcteristics were similar in both groups, except that there were more female patients in the elderly group （21.3% vs 9.8%, P=-0.006）. Primary success rate was similar in both groups （96.5% in young group vs 95.7% in elderly group, P〉0.05）. During angiographic follow-up at 7 months, binary in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups （4.7% vs 1.8%; 9.7% vs 8.8%, P〉0.05 respectively）. Both sub-acute and late thrombosis rates were similar in the two groups （0.3% vs 0.9% and 1.2% vs 0.9%, P〉0.05 respectively. TLFI was not significantly different between the two groups （6.5% vs 3.5%;P=-0.246）. The rates of bleeding, stroke, angina rehospitalization during the, follow-up period were also similar in both groups （P〉0.05 respectively）. Conclusion Despite a high-risk clinical profile, coronary SES implantation can be safely and effectively performed in elderly patients with a similar procedural success rate, a low complication rate, and excellent 7-month outcomes.     

冠心病介入治疗后再狭窄因素分析

目的 探讨冠心病介入治疗后再狭窄与冠心病易患因素关系。方法 冠心病介入治疗４４０例中,选择连续８４例（１１５个狭窄病变）术后随访冠脉造影复查者,冠脉定量分析（ＱＣＡ）术前、术后和随访复查冠脉造影图象,并分析再狭窄与冠心病易患因素的关系。结果患者６个月再狭窄率为４０．００％,多元回归分析再狭窄发生时间与吸烟史、多个易患因素、多支病变、病变类型和前降支病变呈正性相关,与支架置入呈负性相关。结论 冠心     

Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions

Background There are limited data on the efficacy of drug-eluting stents （DES） for treatment of chronic total occlusions （CTO）. The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent （BMS） implantation.
Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 （55.7%） who underwent DES and 524 （44.3%） who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier method.
Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy （（7.4±2.5） months vs （1.7±0.8） months, P 〈0.001）. Average follow-up periods were （4.7±0.89） and （3.2±1.3） years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups （90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38）, but the 5-year target vessel revascularization （TVR）-free survival rate in the DES group was significantly higher than that in the BMS group （81.6% vs 73.5%, Log-rank P 〈0.001）. The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group （80.6% vs 71.5%, Log-rank P〈0.001）. The rates of readmission caused by cardiovascular disease （27.0% vs 37.8%, P 〈0.001） and the need for bypass surgery were significantly lower in the DES group （1.5% vs 3.4%, P 〈0.05）. By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients （HR： 0.492; 95% Cl 0.396-0.656, P 〈0.001）. Left ventricular ejection fraction 〈50% and elderly （〉65 years） were identified as independent predictors of long-term MACE during follow-up.
Conclusion This study demonstrates the long-term （up to 5 years） efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.     

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support

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.     

经双侧桡动脉途径对照造影行冠状动脉慢性闭塞病变介入治疗的研究

目的评价冠状动脉慢性闭塞病变(CTO)介入治疗中经双侧桡动脉途径进行左右冠状动脉造影定位的可行性及安全性。方法选择2006年6月—2007年6月本院行择期冠状动脉造影的CTO患者中存在对侧侧支循环的4例患者,经一侧桡动脉送入导引导管,经另一侧桡动脉送入造影导管,通过对侧造影使侧支循环及闭塞远端显影,帮助判断导丝是否在真腔,证实导丝在真腔后进行球囊扩张及支架置入术。结果4例均经对侧造影行经皮冠状动脉球囊扩张及支架置入,术中均未发生冠状动脉夹层及穿孔等并发症,术后症状明显缓解。结论经双侧桡动脉途径对照造影,通过侧支循环使CTO远端显影帮助判断导丝位置是一种安全有效的介入治疗方法。     

Elective percutaneous intervention for unprotected left main coronary artery stenosis complicated with left anterior descending artery chronic total occlusive lesions

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.     

正向夹层再次进入技术在冠状动脉慢性闭塞病变中的应用

目的：探讨ADR技术在经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）开通冠状动脉慢性完全闭塞（chronic total occlusion,CTO）应用的有效性与安全性。方法：选取2017年1月至2018年12月在滨州市人民医院和南昌大学第二附属医院行PCI的CTO病变中未使用正向夹层再次进入（antegrade dissection re-entry,ADR）技术的48例患者（对照组）和使用ADR技术的50例患者（治疗组）为研究对象。比较2组患者的基线情况、冠状动脉造影结果、PCI成功率和随访12个月的主要不良心血管事件（major adverse cardiovascular events,MACE）。结果：对照组共有52处CTO病变,治疗组共有58处CTO病变。治疗组PCI成功率明显高于对照组（89.7%vs. 71.2%,P=0.047）,其中6例支架内再狭窄型CTO(in-stent restenosis,ISR-CTO)病变全部开通,治疗组平均PCI时间[（71±25） min vs.(95±33) min,P=0.0...