BridgePoint系统开通冠状动脉慢性完全闭塞病变的临床疗效

目的探讨BridgePoint系统支持下正向内膜下重回真腔技术(ADR)开通冠状动脉慢性完全闭塞病变(CTO)的安全性、有效性和预后。方法连续入选自2016年4月至2018年12月于西京医院接受BridgePoint系统开通CTO病变的患者87例,进行回顾性分析。记录入选患者的一般资料、CTO病变的影像学特征及术中相关参数。观察入选患者的短期预后,包括技术成功(达TIMI 3级血流及残余狭窄<30%)率、手术成功住院期间无主要不良心血管事件(MACE)发生]率、并发症以及住院期间MACE。MACE包括死亡、再发心肌梗死、靶血管重建(TVR)和心脏压塞等。于出院后30 d及6、12、24和36个月,通过门诊或电话随访入选患者MACE发生情况。结果87例患者中,男性75例(86%),年龄(61±10)岁,J-CTO评分为(2.49±0.52)分。6例患者采用BridgePoint系统直接行ADR术,均成功。81例患者行BridgePoint系统补救性ADR术,其中62例成功,BridgePoint系统ADR术成功率为78.2%(68/87);19例患者于手术失败后通过正向/逆向技术补救,成功9例,失败10例。技术成功率为88.5%(77/87)。冠状动脉穿孔2例(2.3%),1例置入覆膜支架,1例心包填塞后给予心包穿刺;围手术期心肌梗死1例,猝死1例,心脏压塞1例。住院期间入选患者MACE发生率为3.4%(3/87),手术成功率为85.1%(74/87)。手术时间为(175±72)min,对比剂剂量为(449±155)ml。随访17(11,26)个月,86例患者完成了随访,30 d MACE发生率为4.7%(4/86),6个月为10.5%(9/86),17个月为17.4%(15/86)。结论BridgePoint系统开通冠状动脉CTO的成功率较高,安全、可行,临床预后较好。

Clinical outcomes of opening coronary chronic total occlusion lesions with the assistance of BridgePoint devices

Objective To investigate the safety,efficacy and prognosis of antegrade dissection re-entry(ADR)with the assistance of BridgePoint devices in opening coronary chronic total occlusion(CTO).Methods A total of 87 consecutive patients,who underwent percutaneous coronary intervention using BridgePoint devices from April 2016 to December 2018 in Xijing Hospital,were included in this study.General information of the selected patients,features of CTO lesions and intraoperative parameters were recorded.Short-term outcomes including technical success rate(defined as achieving TIMI 3 blood flow with residual stenosis<30%),surgical success rate(defined as no major adverse cardiovascular events(MACE)occured while hospitalized),complications,and MACE during hospitalization were observed.MACE included death,recurrent myocardial infarction,target vascular reconstruction(TVR)and cardiac tamponade.Patients were followed up by outpatient or telephone visits at 30 days and 6,12,24 and 36 months after discharge.Results Eighty-seven patients,aged(61±10)years with J-CTO scores(2.49±0.52)were included,and 75(86%)were male.Six patients underwent direct ADR with BridgePoint system,and all were successful.Eighty-one patients underwent rescue ADR using BridgePoint devices,and 62 of them were successful.The success rate of ADR with BridgePoint devices was 78.2%(68/87).Nine out of the 19 failed cases succeeded after the application of rescue antegrade/retrograde technique.The technical success rate was 88.5%(77/87).Coronary perforation occurred in 2 cases(2.3%),one case was treated with covered stent and the other case with tamponade was treated with pericardiocentesis.One patient developed periprocedural myocardial infarction,and one patient suffered from sudden death,and one patient had cardiac tamponade.In-hospital MACE occurred in 3(3.4%)patients.The surgical success rate was 85.1%(74/87).The procedure time was(175±72)minutes and the amount of contrast used was(449±155)ml.During a follow-up of 17(11,26)months,the incidence of MACE within 30 days was 4.7%(4/86),while 10.5%(9/86)within 6 months,17.4%(15/86)within 17 months.Conclusion Opening CTO with the assistance of BridgePoint devices is feasible and safe,with high success rate and satisfactory outcome.