【摘要】 目的对比研究改良的交替平行技术硬/软导丝组合与经典"升阶梯"导丝技术突破慢性完全闭塞病变(CTO)的有效性、安全性。方法纳入2012年1月至2015年6月拟行经皮冠状动脉介入治疗(PCI)患者120例,随机分为硬/软导丝组合交替平行技术组(Improved组,61例)和经典"升阶梯"导丝技术组(Classic组,59例)。两组患者PCI均采用正向导丝技术,评估指标包括首次突破成功率、失败后再次突破成功率、导丝耗材数、X线暴露时间、对比剂用量,手术并发症,30 d主要不良心血管事件(MACE)及次要不良事件发生率,术前、术后30 d评估NYHA心功能分级、左心室射血分数(LVEF)、6 min步行试验。结果两组患者基线资料及CTO受累血管部位等造影资料比较,差异均无统计学意义(均P>0.05);Improved组患者首次导丝突破成功率(93.4%比77.9%,P=0.016)高于Classic组;经过交换导丝技术后,Improved组累次导丝突破成功率与Classic组比较(95.1%比96.6%,P=0.742),差异无统计学意义;导丝技术成功患者经球囊预扩张,置入药物洗脱支架均成功。Improved组患者导丝耗材数[3.0(2.0,4.0)根比5.0(3.0,7.0)根,P=0.018]、X线暴露时间[(110±65)min比(175±73)min,P=0.024]、对比剂用量[(210±137)ml比(305±148)ml,P=0.017]均少于Classic组,差异有统计学意义;两组患者冠状动脉夹层、感染、穿刺血肿、假性动脉瘤等发生率比较,差异均无统计学意义(均P>0.05);Improved组患者总体不良事件发生率低于Classic组(16.4%比30.5%,P=0.045);两组患者NYHA心功能Ⅰ级(19.7%比11.9%,P=0.062)比较,差异无统计学意义,而Improved组患者NYHA心功能Ⅱ级(45.9%比32.2%,P=0.038)高于Classic组,Ⅲ级(26.3%比37.3%,P=0.047)、Ⅳ级(8.2%比18.6%,P=0.026)低于Classic组;Improved组患者LVEF[(51.5±10.3)%比(47.3±11.4)%,P=0.029]、6 min步行距离[(437±43)m比(376±52)m,P=0.031]均高于Classic组。结论改良的交替平行技术硬/软导丝组合安全性好,突破困难和非常困难CTO的有效性、手术成功率优于经典"升阶梯"导丝技术。更多还原

【Abstract】 Objective To compare the"Improved seesaw wiring"technique to the classic"seesaw wiring"method for its effectivenss and safety in the management of CTO lesions. Methods A retrospective study was conducted including 120 patients with 145 CTO lesions who were admitted in our hospital from January 2011 to June 2015. In the "Improved " group( n = 61),the CTO lesions were treated with"Improved seesaw wiring"guidewire technique by alternate application of hand/soft guidwires and in the"Classic"group( n = 59) classic seesaw wiring technique was performed using soft,intermediate to a stiff-tip guidewire step by step. Procedural success rates,material consumption,radiation exposure,major adverse cardiac events in 30 days,and improvement in cardiac function postoperation were compared between the 2groups. Results The procedural success rates by first attempt was 93. 4% in the ″ Improved″ group and77. 9% in the "Classic " group and the overall procedural success rates were 95. 1% and 96. 6%respectively. Guidewire consumption [( 3. 0( 2. 0,4. 0) guidewires vs. 5. 0( 3. 0,7. 0) guiderwires],Xray exposure [( 110 ± 65) min vs.( 175 ± 73) min],contrast media used [( 210 ± 137) ml vs.( 305 ± 148)ml] were all fewer or less in the"Improved group"( all P < 0. 05). No significant difference found in rates of procedural complications between the 2 groups. MACE rates were lower in the "Improved "technique group( 16. 4% vs. 30. 5%,P = 0. 045). In terms of postoprative cardiac function,the LVEF and distance for 6-minute-walk were higher in the "Improved" group. Conclusions The "Improved seesaw wiring "guidewire technique in PCI for difficult CTO lesions can enhance success rates of PCI with an low major complication rate.更多还原