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Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention 下载免费PDF全文
Cathérine Gebhard MD Michael Gick MD Miroslaw Ferenc MD Barbara E. Stähli MD Fadil Ademaj MD Kambis Mashayekhi MD Heinz Joachim Buettner MD Franz‐Josef Neumann MD Aurel Toma MD 《Catheterization and cardiovascular interventions》2018,91(4):669-678
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目的:通过冠状动脉慢性闭塞病变(CTO)患者冠脉介入治疗(PCI)经验总结探讨开通CTO对于患者临床症状、左室功能、存活率和生活质量的影响。方法: 选择于心内科病房住院接受冠脉造影、其中至少1支冠脉主支血管为CTO并接受PCI的患者,根据PCI手术是否成功分为成功组和失败组。应用正向导丝技术处理病变。出院后1年对患者进行随访。评价的终点事件包括死亡、心肌梗死、中风、再次PCI治疗和冠状动脉旁路移植术(CABG)。对各项数据进行统计学分析。结果: 434名入选患者,CTO介入治疗成功316名,失败118名。PCI失败组患者既往接受PCI手术(P<0.01)或CABG术(P<0.01)显著高于PCI成功组,高龄和吸烟比例也显著高于PCI成功组。两组患者在高血压病、高血脂、陈旧心梗及糖尿病等病史和心功能方面没有显著差别。PCI失败组两支CTO病变以及多支血管病变比率均显著高于PCI成功组患者(均P<0.01)。术后1年两组患者在死亡、心梗、中风和再次PCI方面没有显著差异,失败组患者心绞痛发生率高(P<0.01),介入术后进行择期CABG手术比例高于成功组患者(P<0.01)。结论: 开通CTO可显著降低患者心绞痛和CABG手术率,而死亡、心梗、中风和再次PCI方面没有显著差异。 相似文献
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Alexandre Avran MD Andrea Zuffi MD Cecilia Gobbi MD Alessio Gasperetti MD Marco Schiavone MD Gerald S. Werner MD PhD Mashayekhi Kambis MD Nicolas Boudou MD Alfredo R. Galassi MD George Sianos MD PhD Moussa Idali MD Roberto Garbo MD Andrea Gagnor MD Gabriele Gasparini MD Alexander Bufe MD Leszek Bryniarski MD PhD Artis Kalnins MD Daniel Weilenmann MD Jaroslaw Wojcik MD Pierfrancesco Agostoni MD Nenad Z. Bozinovic MD Mauro Carlino MD Sergey Furkalo MD David Hildick-Smith MD Laurent Drogoul MD Julien Lemoine MD Antonio Serra MD PhD Stefano Carugo MD Imre Ungi MD Joseph Dens MD Nicolaus Reifart MD PhD Joseph Cosma MD Vincenzo Mallia MD Giuseppe Vadalà MD Giuseppe Biondi-Zoccai MD PhD Carlo Di Mario MD PhD 《Catheterization and cardiovascular interventions》2023,101(5):918-931
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Lorenzo Azzalini Barry Uretsky Emmanouil S. Brilakis Antonio Colombo Mauro Carlino 《Catheterization and cardiovascular interventions》2019,93(1):E24-E29
The intraplaque injection of contrast media in the recanalization of coronary chronic total occlusions (CTO) has witnessed a dynamic journey since its initial formulation. Contrast‐guided subintimal tracking and re‐entry (STAR) was the first contrast modulation technique for CTO percutaneous coronary intervention (PCI). With this technique, a forceful injection of a large volume of contrast (3–4 mL) was performed in order to achieve hydraulic recanalization of the vessel. This approach was associated with extensive vessel injury and unpredictable true lumen re‐entry, which were in turn linked to high rates of restenosis on follow‐up. In the subsequent iteration, called the “microchannel technique”, a smaller amount of contrast media (1 mL) was gently injected inside the plaque to modify its compliance by softening and recruiting loose tissue, which facilitated subsequent true‐to‐true lumen crossing with a polymer‐jacketed wire along paths of least resistance. The microchannel technique has later evolved into what is currently known as the “Carlino technique”, where a minimal volume of contrast media (<0.5 mL) is gently injected inside the occlusion, with the goal of modifying plaque compliance to facilitate guidewire and microcatheter advancement through a fibrocalcific plaque. The Carlino technique is now widely utilized to allow negotiation of difficult‐to‐cross occlusions, particularly by the “hybrid operators”, with high success rates and low incidence of complications. The purpose of this article is to provide a historical perspective on the use of contrast modulation in CTO PCI, its pathophysiological basis, as well as technical recommendations on how and when to perform these maneuvers. 相似文献
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目的]系统评价冠状动脉慢性完全闭塞病变(CTO)患者经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)的影响因素。[方法]计算机检索PubMed、EMBASE、the Cochrane Library、CNKI、VIP及WanFang Data数据库,搜集关于CTO患者PCI术后MACE影响因素的队列研究,检索时限均为建库至2021年10月。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R3.6.2软件进行Meta分析。[结果]共纳入30项队列研究,包含25 002名CTO患者。Meta分析结果显示:8个影响因素具有统计学意义,分别为年龄(RR=1.06,95%CI为1.01~1.10,P=0.01)、男性(RR=1.68,95%CI为1.17~2.42,P<0.01)、既往冠状动脉搭桥术(RR=1.50,95%CI为1.12~1.99,P<0.01)、糖尿病史(RR=1.51,95%CI为1.15~1.99,P<0.01)、肾功能不全(RR=2.91,95%CI为2.44~3.48,P<0.01)、支架内闭塞病变(RR=2.15,95%CI为1.08~4.31,P=0.03)、PCI成功(RR=0.52,95%CI为0.38~0.72,P<0.01)和最小管腔直径(RR=0.47,95%CI为0.31~0.70,P<0.01)。[结论]当前证据表明,年龄、男性、既往冠状动脉搭桥术、糖尿病史、肾功能不全、支架内闭塞病变是CTO患者PCI术后发生MACE的危险因素,而PCI成功和最小管腔直径是CTO患者PCI术后发生MACE的保护因素。 相似文献
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Evangelia Vemmou MD Khaldoon Alaswad MD Mitul Patel MD Ehtisham Mahmud MD James W. Choi MD Farouc A. Jaffer MD PhD Anthony H. Doing MD Phil Dattilo MD Dimitri Karmpaliotis MD PhD Oleg Krestyaninov MD Dmitrii Khelimskii MD Ilias Nikolakopoulos MD Judit Karacsonyi MD PhD Iosif Xenogiannis MD PhD Santiago Garcia MD M. Nicholas Burke MD Nidal Abi Rafeh MD Ahmed ElGuindy MD MSc Omer Goktekin MD Abir Abdo MD Bavana V. Rangan BDS MPH Shuaib Abdullah MD Emmanouil S. Brilakis MD PhD 《Journal of the American Geriatrics Society》2021,69(6):1560-1569
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目的:总结Fielder XT导丝在功能性慢性完全闭塞(CTO)病变介入治疗中的使用体会和经验。方法:回顾分析我科2011年1月~2012年10月住院使用过Fielder XT导丝行介入治疗的CTO病变患者的影像资料。根据CTO病变的影像特点将患者分为绝对性CTO病变组和功能性CTO病变组,分别统计上述两组的CTO病变经皮冠状动脉介入治疗(PCI)成功率,统计两组的Fielder XT导丝的CTO病变通过率,并进行比较分析。结果:功能性CTO病变组和绝对性CTO病变组CTO病变的成功率分别为89%、60%(40/45、22/37,P0.01);两组Fielder XT导丝的通过率分别为:71%、24%(32/45、9/37,P0.01)。结论:Fielder XT在功能性CTO病变中有较高的导丝通过率。 相似文献
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目的探讨双联抗血小板治疗(DAPT)评分是否可用于指导冠状动脉慢性闭塞病变(CTO)患者经皮冠状动脉介入(PCI)术后的双联抗血小板药物治疗。方法选取2014年1月至2017年6月于白求恩国际和平医院心血管内科接受PCI治疗的CTO患者497例,应用DAPT评分工具评估,分别观察≥2分及<2分的患者采用标准双联抗血小板治疗(12个月)或延长治疗(12~58个月)的主要心脑血管事件(MACCE)发生率及出血情况。采用SPSS 22.0软件进行数据统计分析。结果共入组患者405例,随访时间34(28,44)个月。(1)在DAPT评分≥2分的患者中,延长双抗治疗组较标准双抗治疗组MACCE的发生率低,差异有统计学意义(5.5%和14.0%,P=0.040)。延长双抗治疗组心源性死亡、靶血管血运重建的发生率低于标准双抗治疗组,分别为(1.8%和8.6%,1.8%和8.6%),差异均有统计学意义(P<0.05)。Kaplan-Meier分析显示,延长双抗治疗组与标准双抗治疗组MACCE生存率比较,差异有统计学意义(P=0.046)。(2)在DAPT评分<2分的患者中,2组MACCE的比较,差异无统计学意义(P<0.05)。标准双抗治疗组的BARC 2,3,5型出血事件显著低于延长双抗治疗组(3.4%和12.8%,P=0.018)。Kaplan-Meier分析显示,标准双抗治疗组较延长双抗治疗组无出血事件生存率高(P=0.034)。结论DAPT评分可用于指导CTO患者PCI术后双抗治疗的时程,≥2分的CTO患者PCI术后给予延长的双联抗血小板治疗获益更多,<2分的患者给予标准时程的双联抗血小板治疗出血风险更低。 相似文献
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Athanasios Rempakos MD Spyridon Kostantinis MD Bahadir Simsek MD Judit Karacsonyi MD PhD Michaella Alexandrou MD James W. Choi MD Paul Poommipanit MD Jaikirshan J. Khatri MD Laura Young MD Rhian Davies DO MS Stewart Benton MD Farouc A. Jaffer MD PhD Raj Chandwaney MD Lorenzo Azzalini MD PhD MSc Khaldoon Alaswad MD Brian Jefferson MD Jarrod Frizzell MD Nidal Abi-Rafeh MD Ahmed Elguindy MD Omer Goktekin MD Bavana V. Rangan BDS MPH Olga C. Mastrodemos BA Salman S. Allana MD Yader Sandoval MD Nicholas M. Burke MD Emmanouil S. Brilakis MD PhD Sevket Gorgulu MD 《Catheterization and cardiovascular interventions》2023,102(5):857-863
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Sanjog Kalra MD MSc Darshan Doshi MD MS James Sapontis MBBCh Ioanna Kosmidou MD PhD Ajay J. Kirtane MD SM Jeffrey W. Moses MD Robert F. Riley MD MS Philip Jones MS William J. Nicholson MD Adam C. Salisbury MD MSc William L. Lombardi MD James M. McCabe MD Ashish Pershad MD Taishi Hirai MD Emad Hakemi MD Juan J. Russo MD Megha Prasad MD Yousif Ahmad MD Raja Hatem MD Fotis Gkargkoulas MD John A. Spertus MD MPH R. Michael Wyman MD Farouc Jaffer MD PhD Anthony Spaedy MD Stephen Cook MD Steven P. Marso MD Karen Nugent RRT Robert Federici MD Robert W. Yeh MD MBA Martin B. Leon MD Gregg W. Stone MD Ziad A. Ali MD DPhil Manish A. Parikh MD Akiko Maehara MD David J. Cohen MD MSc Candido Batres MD J. Aaron Grantham MD Dimitri Karmpaliotis MD PhD 《Catheterization and cardiovascular interventions》2021,97(6):1162-1173
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Galassi AR Tomasello SD Costanzo L Campisano MB Barrano G Ueno M Tello-Montoliu A Tamburino C 《Catheterization and cardiovascular interventions》2012,79(1):30-40
Background: Although the advancement of the equipment and the presence of innovative techniques, percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to be affected by lower procedural success in comparison with non occluded vessel PCI. Objective: We describe a new technique for the treatment of coronary CTO which utilizes a new generation of polymeric wires. Methods and Result: From March 2009 to June 2010 different strategies were adopted as “bail out” after an initial attempt failed in 117 consecutive CTO lesions. Among these, conventional strategies (CS) such as parallel wire, sub‐intimal tracking and re‐entry (STAR), microchannel technique, intracoronary ultrasound guided revascularization and anchor balloon, were used in 75 cases (64.1%), while in the remaining a new technique, the “mini‐STAR,” was used (39.9%). Although no substantial differences were observed regarding the distribution of clinical features and angiographic lesions characteristics between the populations, mini‐STAR was able to achieve a higher rate of procedural success in comparison with other CS (97.6% vs. 52%, P < 0.001) with lower contrast agent use (442 ± 259 cm3 vs. 561 ± 243 cm3, P = 0.01) and shorter procedural and fluoroscopy times (122 ± 61 vs. 157 ± 74 min, P = 0.009 and 60 ± 31 min vs. 75 ± 38 min, P = 0.03, respectively). No differences were observed in term of peri‐procedural complications such as procedural myocardial infarction, coronary perforations, and contrast‐induced nephropathy between mini‐STAR and CS. Conclusion: The mini‐STAR technique is a promising strategy for the treatment of CTO lesions, achieving a high procedural success rate and low occurrence of procedural adverse events. © 2011 Wiley Periodicals, Inc 相似文献
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Lorenzo Azzalini MD PhD MSc Francesco Moroni MD Kathryn L. Dawson MD Kathleen E. Kearney MD 《Catheterization and cardiovascular interventions》2023,101(1):102-107
Cardiac allograft vasculopathy (CAV) is frequently observed after heart transplant (HT), and represents one of the main causes of chronic rejection, graft loss, and death. While the role of percutaneous coronary intervention (PCI) is well established in the management of CAV in cases of nonocclusive stenoses, the outcomes and technical aspects of this procedure in chronic total occlusions (CTOs) are unknown. We describe our experience with three cases in which CTO PCI was indicated to treat CAV in HT recipients, and we discuss the peculiarities and therapeutic approach to this challenging patient population. In particular, all patients were asymptomatic for angina, and CTO PCI was indicated to promote recovery of left ventricular function, extend graft survival, and/or protect from future ischemic events. CTO PCI was performed using hybrid techniques and was successful in all three cases. Intravascular imaging was used in all cases to maximize the durability of the procedure. 相似文献
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Stefan P. Schumacher MD Henk Everaars MD Wijnand J. Stuijfzand MD Pepijn A. van Diemen MD Roel S. Driessen MD Michiel J. Bom MD Ruben W. de Winter MD Yvemarie B. O. Somsen MD Jennifer W. Huynh BSc Ramon B. van Loon MD PhD Peter M. van de Ven PhD Albert C. van Rossum MD PhD Maksymilian P. Opolski MD PhD Alexander Nap MD PhD Paul Knaapen MD PhD 《Catheterization and cardiovascular interventions》2021,98(5):E668-E676
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Loes P. Hoebers MD Bimmer E. Claessen MD PhD George D. Dangas MD PhD Seung‐Jung Park MD Antonio Colombo MD Jeffrey W. Moses MD José P.S. Henriques MD PhD Gregg W. Stone MD Martin B. Leon MD Roxana Mehran MD the Multinational CTO Registry 《Catheterization and cardiovascular interventions》2013,82(1):85-92
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Yvemarie B. O. Somsen MD Ruben W. de Winter MD Rocco Giunta MD Stefan P. Schumacher MD PhD Pepijn A. van Diemen MD Ruurt A. Jukema MD Wijnand J. Stuijfzand MD PhD Ibrahim Danad MD PhD Birgit I. Lissenberg – Witte PhD Niels J. Verouden MD PhD Alexander Nap MD PhD Sebastiaan A. Kleijn MD PhD Alfredo R. Galassi MD PhD José P. Henriques MD PhD Paul Knaapen MD PhD 《Catheterization and cardiovascular interventions》2023,102(5):844-856
Background
The Japanese Channel (J-Channel) score was introduced to aid in retrograde percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs). The predictive value of the J-Channel score has not been compared with established collateral grading systems such as the Rentrop classification and Werner grade.Aims
To investigate the predictive value of the J-Channel score, Rentrop classification and Werner grade for successful collateral channel (CC) guidewire crossing and technical CTO PCI success.Methods
A total of 600 prospectively recruited patients underwent CTO PCI. All grading systems were assessed under dual catheter injection. CC guidewire crossing was considered successful if the guidewire reached the distal segment of the CTO vessel through a retrograde approach. Technical CTO PCI success was defined as thrombolysis in myocardial infarction flow grade 3 and residual stenosis <30%.Results
Of 600 patients, 257 (43%) underwent CTO PCI through a retrograde approach. Successful CC guidewire crossing was achieved in 208 (81%) patients. The predictive value of the J-Channel score for CC guidewire crossing (area under curve 0.743) was comparable with the Rentrop classification (0.699, p = 0.094) and superior to the Werner grade (0.663, p = 0.002). Technical CTO PCI success was reported in 232 (90%) patients. The Rentrop classification exhibited a numerically higher discriminatory ability (0.676) compared to the J-Channel score (0.664) and Werner grade (0.589).Conclusions
The J-channel score might aid in strategic collateral channel selection during retrograde CTO PCI. However, the J-Channel score, Rentrop classification, and Werner grade have limited value in predicting technical CTO PCI success. 相似文献20.
Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: Eight‐year experience and outcomes by a propensity score ascertainment 下载免费PDF全文
Natasza Gilis‐Malinowska MD Marcin Fijalkowski MD Radoslaw Targonski MD Emilia Masiewicz MD Aneta Strozyk MD Maciej Duda MD Michal Chmielecki MD Lukasz Lewicki MD Witold Dubaniewicz MD Slawomir Burakowski MD Piotr Drewla MD Pawel Skarzynski MD Andrzej Rynkiewicz MD Jasmina Alibegovic MD Ulf Landmesser MD Marcin Gruchala MD 《Catheterization and cardiovascular interventions》2015,86(2):E49-E57