"Crowbar Effect"技术促进球囊跨过高阻力冠状动脉慢性完全性闭塞病变的有效性和安全性研究

doi:10.12114/j.issn.1007-9572.2023.0147

摘要/Abstract

摘要： 背景经皮冠状动脉介入治疗（PCI）开通冠状动脉慢性完全性闭塞（CTO）失败的原因之一是球囊不能跨过CTO病变。目的评估"Crowbar Effect"技术促进球囊穿过冠状动脉高阻力CTO病变的有效性和安全性，为开通CTO提供一种可选择的新技术和提高CTO开通的成功率。方法选择2010年1月—2019年1月在首都医科大学附属北京安贞医院和北华大学附属医院应用前向技术治疗冠状动脉CTO病变患者648例，其中导丝通过了病变，而球囊不能跨过的高阻力CTO病变84例（12.96%），对其应用"Crowbar Effect"技术促使小球囊通过CTO病变，完成PCI。观察PCI成功率和主要不良心血管事件（MACE）。结果 84例CTO病变的J-score评分为（1.63±0.90）分。在第1条导丝成功穿过CTO病变后，由于使用了"Crowbar Effect"技术，小球囊穿透CTO病变的成功率为91.67%（77/84）。仍有7例（8.33%）失败，其中2例因360°严重钙化病变和5例冠状动脉穿孔而失败。84例患者未发生围术期心源性死亡和非致死性心肌梗死。结论 "Crowbar Effect"技术是一种有效且安全的技术，可使小型球囊穿过普通球囊不可穿透的CTO病变。应用这种简单的技术开通CTO有很高的成功率和应用价值。

关键词: 冠状动脉闭塞, 冠状动脉慢性完全性闭塞, 撬杠作用, 冠状动脉介入治疗, 治疗效果, 安全性

Abstract:

Background

The inability of the balloon to cross coronary chronic total occlusion (CTO) lessions is one of the reasons for the failure of percutaneous coronary intervention (PCI) in the revascularization of CTO.

Objective

To evaluate the efficacy and safety of the "Crowbar Effect" technique to facilitate balloon crossing resistant CTO lesions, so as to provide an alternative novel technique for CTO recanalization and improving the success rate of CTO recanalization.

Methods

A total of 648 patients with coronary artery CTO lesions treated by antegrade approach at Beijing Anzhen Hospital, Capital Medical University and the Affiliated Hospital of Beihua University from January 2010 to January 2019 were collected, 84 (12.96%) cases of whom suffered from resistant CTO lesions which could be not crossed with balloon after the first guide wire successfully crossed the lesions. The "Crowbar Effect" technique was applied to those patients to facilitate the small-sized balloon crossing CTO lesions to complete PCI. The success rate of PCI and incidence of major adverse cardiac events (MACE) were observed.

Results

The average J-score of CTO lesions in 84 patients was (1.63±0.90). After successful crossing of the first guide wire through the CTO lesions, the success rate of small-sized balloon crossing CTO lesions was 91.67% (77/84) due to the use of "Crowbar Effect" technique. There were still failures in 7 cases (8.33%), including 2 cases caused by 360-degree severe calcified lesions and 5 cases caused by coronary artery perforation. No perioperative cardiac death or nonfatal myocardial infarction occurred in 84 patients.

Conclusion

The "Crowbar Effect" technique is effective and safe in facilitating small-sized balloons to cross balloon uncrossable CTO lesions. The application of this simple technique has a high success rate and application value for CTO recanalization.

Key words: Coronary occlusion, Coronary chronic total occlusions, Crowbar effect, Percutaneous coronary intervention, Treatment efficacy, Safety

刘睿方,徐方兴,刘同库,等. "Crowbar Effect"技术促进球囊跨过高阻力冠状动脉慢性完全性闭塞病变的有效性和安全性研究[J]. 中国全科医学, 2023, 26(29): 3683-3688. DOI: 10.12114/j.issn.1007-9572.2023.0147.
LIU Ruifang,XU Fangxing,LIU Tongku, et al. Evaluation of the Efficacy and Safety of "Crowbar Effect" Technique to Facilitate Balloon Crossing Resistant Chronic Total Occlusions Lesions[J]. Chinese General Practice, 2023, 26(29): 3683-3688. DOI: 10.12114/j.issn.1007-9572.2023.0147.

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病变部位	例数	J-score评分〔例（%）〕				平均分（±s，分）
病变部位	例数	0分	1分	2分	3分	平均分（±s，分）
RCA	43	5（11.63）	9（20.93）	22（51.16）	7（16.28）	1.72±0.88
LAD	19	2（10.53）	3（15.79）	13（68.42）	1（5.26）	1.68±0.75
LCX	22	6（27.27）	4（18.18）	9（40.91）	3（13.64）	1.41±1.05
合计	84	13（15.48）	16（19.05）	44（52.38）	11（13.09）	1.63±0.90

病变部位	例数	J-score评分〔例（%）〕				平均分（±s，分）
病变部位	例数	0分	1分	2分	3分	平均分（±s，分）
RCA	43	5（11.63）	9（20.93）	22（51.16）	7（16.28）	1.72±0.88
LAD	19	2（10.53）	3（15.79）	13（68.42）	1（5.26）	1.68±0.75
LCX	22	6（27.27）	4（18.18）	9（40.91）	3（13.64）	1.41±1.05
合计	84	13（15.48）	16（19.05）	44（52.38）	11（13.09）	1.63±0.90

病变部位	例数	加压次数（次）	成功率〔例（%）〕	未成功〔例（%）〕	穿孔率〔例（%）〕
RCA	43	10.37±3.31	40（93.02）	3（6.98）	3（6.98）
LAD	19	9.74±2.62	17（89.47）	2（10.53）	1（5.26）
LCX	22	9.59±3.19	20（90.91）	2（9.09）	1（4.55）
合计	84	10.02±3.12	77（91.67）	7（8.33）	5（5.95）

病变部位	例数	加压次数（次）	成功率〔例（%）〕	未成功〔例（%）〕	穿孔率〔例（%）〕
RCA	43	10.37±3.31	40（93.02）	3（6.98）	3（6.98）
LAD	19	9.74±2.62	17（89.47）	2（10.53）	1（5.26）
LCX	22	9.59±3.19	20（90.91）	2（9.09）	1（4.55）
合计	84	10.02±3.12	77（91.67）	7（8.33）	5（5.95）