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目的:对2012年中国冠状动脉慢性闭塞病变俱乐部(CTOCC)入选患者的介入治疗操作成功率及其成功因素进行分析。方法:观察入选CTOCC的21例患者,分析介入治疗过程特点、即刻造影成功率及操作成功率。结果:21例患者均为外院或中山医院首次介入治疗失败者,闭塞时间为3~60个月。所有患者术前均完成冠状动脉(冠脉)CT检查,双侧穿刺造影使用率为100%。其中17例前向导丝通过法成功完成介入治疗,最常使用的技术为平行导引钢丝技术;4例逆向技术成功开通血管,其中3例使用Reverse Cart技术。平均钢丝使用数量为4.24根,术者首先尝试使用软导引钢丝者19例(90.5%),其中最常使用的是锥形导丝Fielder XT,占(52.6%),其次为Sion导丝(26.3%),其中成功者5例(23.8%),多数需要使用硬导引钢丝通过病变(76.2%),通过CTO病变术者最常使用的硬导引钢丝为Conquest(42.9%)系列导引钢丝,其次为CrosswireNT导丝(28.6%)。术中微导管使用率为100%,其中Cosair导管最常使用(76.2%)。操作中血管内超声(IVUS)的使用率为42.9%,主要用于判断导丝远端是否位于真腔、植入支架时管腔直径判断以及寻找闭塞血管入口。21支闭塞血管成功植入支架46枚,平均2.19个,均为药物洗脱支架,PCI成功率达100%。住院期间无主要心血管事件发生。结论:2012年CTOCC病例介入治疗全部获得成功,可能与术者术前充分读片,指导操作的辅助检查使用率高,术中合理使用导丝和相关器械,IVUS使用充分有关。
OBJECTIVE: To analyze the success rate and success factors of interventional therapy in patients enrolled in the 2012 China Coronary Artery Chronic Obstructive Disease Club (CTOCC). Methods: Twenty-one patients were selected for CTOCC. The characteristics of interventional therapy, the success rate of immediate angiography and the success rate of operation were analyzed. Results: Twenty-one patients were either the first hospital or the Zhongshan Hospital for failure of interventional therapy, and the occlusion time was 3 to 60 months. Coronary artery (coronary) CT examination was performed in all patients before surgery. The biopsy rate was 100%. Among them, 17 cases of anterior guidewire were successfully treated by interventional method. The most commonly used technique was parallel guided wire technique; 4 cases of reverse technique successfully opened the blood vessels, of which 3 cases used Reverse Cart technique. The average number of wires used was 4.24. The surgeon first attempted to use soft guide wire in 19 cases (90.5%). The most commonly used was Fielder XT (52.6%), followed by Sion’s guide wire 26.3%), of which 5 (23.8%) were successful, most requiring the use of hard guide wire through the lesion (76.2%), the Conquest (42.9%) series guide using the most commonly used hard guide wire for CTO lesions Wire, followed by Crosswire NT guide wire (28.6%). Intraoperative microcatheter utilization was 100%, of which Cosair catheter was the most commonly used (76.2%). In operation, IVUS was used at a rate of 42.9%. It was mainly used to determine whether the distal end of the guidewire was located in the true lumen, to determine the diameter of the lumen when the stent was implanted, and to find the occlusion vessel entrance. Forty-six stents were implanted successfully in 21 occlusive vessels, with an average of 2.19, all of whom were drug-eluting stents. The success rate of PCI was 100%. No major cardiovascular events occurred during hospitalization. Conclusion: All CTOCC cases were successfully treated in 2012, which may be related to the full preoperative reading of the operatives, the high rate of auxiliary examinations for guiding operation, the rational use of guide wire and related instruments during operation, and the sufficient use of IVUS.