【摘要】 目的探讨Guidezilla^TM延长导管在冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）行逆向经皮冠状动脉介入治疗时协助导丝通过闭塞病变与导丝体外化的可行性以及安全性。方法回顾性分析广东省人民医院119例CTO患者。其中,2015年1月至2015年10月入选80例未使用Guidezilla^TM延长导管的反向控制性前向与逆向内膜下寻径（controlled anterograde and retrograde sub-intimal tracking,CART）技术的患者（Non-Guidezilla组）,2015年10月至2016年11月入选39例使用Guidezilla^TM延长导管的反向CART技术的患者（Guidezilla组）。结果本研究中反向CART技术总体成功率为84.0%（100/119）。Guidezilla组成功率（100%比76.2%,P<0.05）高于Non-Guidezilla组,差异有统计学意义;两组患者平均J-CTO评分为2.67,Guidezilla组手术困难（35.9%比15.0%,P<0.001）和非常困难（61.5%比32.5%,P<0.001）的患者比例均高于Non-Guidezilla组,差异均有统计学意义;Guidezilla组二次手术率（25.6%比63.8%,P<0.001）及开口/分叉病变比例（30.8%比62.5%,P=0.002）均低于Non-Guidezilla组,差异均有统计学意义;Guidezilla组闭塞近段刀割状（53.8%比32.5%,P=0.030）、闭塞段长度>20 mm（89.7%比72.5%,P=0.035）及闭塞段弯曲>45°（84.6%比63.8%,P=0.020）的比例均高于Non-Guidezilla组,差异均有统计学意义。结论对于长迂曲的复杂CTO患者,逆向导丝与微导管难以通过病变并进入正向指引时,Guidezilla^TM延长导管能提供安全有效的解决方案。更多还原

【Abstract】 Objective To evaluate the feasibility and efficacy of Guidezilla TM guide extension catheter in retrograde technique for chronic total occlusion(CTO) recanalization. Methods We retrospectively collected 119 CTO cases from the 2 nd Cardiology Department of Guangdong General Hospital who had received retrograde percutaneous coronary intervention( PCI). The Guidezilla TM guide extension catheters were applied in 39 cases from October 2015 to November 2016. 80 CTO cases without using the Guidezilla TM guide extension catheter during PCI admitted between January 2015 and October 2015 were collected as the control. Results The overal success rate of the 2 group was 84.0%. The group using the Guidezilla TM guide extension catheter had a higher success rate(100% vs. 76.2%,P<0.05).The baseline clinical characteristics of the two groups showed no statistical diff erence. In terms of CTO crossing difficulty by J-CTO score, patient in the Guidezilla TM guide extension catheter group had higher percentage of difficult lesions(35.9% vs. 15.0%,P<0.001)and very difficult lesions(61.5% vs. 32.5%, P<0.001).Patients in the Guidezilla TM guide extension catheter group had more longer lesions(89.7% vs. 72.5%,P=0.035), blunt proximal occlusion(53.8% vs. 32.5%,P=0.030)and tortuosity lesions(84.6% vs. 63.8%,P=0.020).More cases in the control group needed a second operation(63.8% vs. 25.6%,P<0.001)and more ostial/bifurcation lesions(62.5% vs. 30.8%,P=0.002). All cases had no target vessel revascularization or inhospital death. Conclusions Guidezilla TM guide extension catheter is convenient and safe for complicated CTO retrograde PCI.更多还原