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

Clinical analysis of antegrade dissection re-entry technique for coronary chronic occlusion lesion

摘要:

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=0.041]、X线曝光时间[（42±17） min vs. （71±22） min，P=0.032]、对比剂使用剂量[（98±26） mL vs.（178±63） mL，P=0.029]明显低于对照组，差异均有统计学意义。治疗组随访12个月MACE发生率（22.0％ vs. 41.7％，P=0.046）及再发心肌梗死发生率（10.0％ vs. 27.1％，P=0.047）明显低于对照组，差异有统计学意义。结论 冠状动脉CTO病变PCI时，应用ADR技术安全、有效，缩短了手术时间，降低了医患的辐射剂量及对比剂的使用剂量，改善了患者预后。

Abstract:

Objective To investigate the efficacy and safety of antegrade dissection re-entry（ADR） technique in percutaneous coronary intervention （PCI） in coronary chronic total occlusion（CTO） lesions.Methods A total of 98 patients with CTO who received PCI treatment in Binzhou People's Hospital and The Second Affiliated Hospital of Nanchang University from January 2017 and December 2018 were included in the study. Among them，48 patients were given traditional PCI treatment without ADR technique（control group） and 50 patients were treated with ADR technique（treatment group）. The baseline conditions， coronary angiography results，PCI success rate，and major adverse cardiovascular events（MACE） for 12 months of follow-up were compared between the two groups.Results There were 52 CTO lesions in 48 patients in the control group and 58 ones in 50 patients in the treatment group. The success rate of PCI in the treatment group was significantly higher than that in the control group（89.7% vs. 71.2%，P=0.047），in which，6 cases of CTO due to in-stent restenosis（ISR-CTO） in treatment group were all open. The mean PCI time [（71±25） min vs. （95±33） min，P=0.041]，X-ray exposure time [（42±17） min vs. （71±22） min，P=0.032] and contrast dose [（98±26） mL vs. （178±63） mL，P=0.029] in the treatment group were significantly lower than those in the control group，and all the differences were statistically significant. The incidence of MACE（22.0% vs. 41.7%， P=0.046） and recurrent myocardial infarction（10.0% vs. 27.1%，P=0.047） after 12 months of follow-up were significantly lower in the treatment group than in the control group，and the differences were statistically significant.Conclusion The application of ADR in coronary CTO lesion PCI is safe and effective，which shortens the operation time，reduces the radiation dose and contrast dose of doctors and patients，and improves the prognosis of patients.