Study On Clinical Application Of Balloon Inching Dilatation In CTO Lesions

Background: coronary arterial chronic total occlusion(CTO),a kind of severe coronary arterial lesions,is the last stage in the natural course of coronary artery stenosis,and it is also the last challenge that the coronary interventional surgery need to conquer.PCI is the main treatment for CTO.When dealing with CTO,the thread goes through the block section that other surgical instruments cannot pass.Different methods(such as buddy wire,micro-channel stracking technique,side branch technique,subintimal tracking and re-entry,anchor balloon technique,IVUS guided CTO intervention,etc.)from different clinical settings vary.The expansion method of balloon is an effective method to deal with the lesions which can not to be passed by the traditional balloon,which is utilized in the cardiac department of jiangxi provincial people’s hospital.The application of balloon expansion method,significantly increased the success rate of operation of CTO lesions,and reduced the operation time and X-ray exposure time.Objective: To compare the efficacy of balloon inching dilatation and buddy wire in treatment of chronic total occlusion(CTO)of coronary artery.Methods:124patients with CTO of coronary artery were divided into two groups according to the different operation methods.The observation group with balloon inching dilatation consisted of 51 patients,and the control group with buddy wire included 73 patients.The surgical successful rate,X-ray exposure time,operation time,dosage of contrast agent,and complications and cardiac adverse events(including myocardial infarction,acute or subacute thrombosis,ventricular fibrillation,pulmonary edema,coronary artery bypass graft,cardiac shock,cardiac death,and cardiovascular events)were compared between two groups.Patients’ serum cTnI and CK-MB were measured preoperatively and 24 hours postoperatively by using enzyme linked immunosorbent assay(ELISA)kits.By comparing the differences of serum cTnI and CK-MB between the observation group and control group,to further investigate whether surgical methods were influential factor to myocardial reperfusion injury.Inaddition,to explore whether surgery attributed to myocardial reperfusion injury,preoperative and 24-hour postoperative serum cTnI and CK-MB were compared in both groups.Results: The surgical successful rate in the observation group was significantly higher than control group(96.08% vs 84.93%).The operation time(130.25±18.66 min vs 165.14±25.24min),X-ray exposure time(67.06±8.08 min vs 87.07±12.93min),and dosage of contrast agent(135.9±22.72 ml vs 184.9±33.40ml)were in the observational group significantly lower than control group.All patients in both groups had no postoperative complications and cardiac adverse events except 1patient with cardiac shock in the control group.Myocardial reperfusion injury was present in both observation group and control group,and the degrees of myocardial reperfusion injury were comparable.Conclusion: When the balloon is difficult to go through the CTO of coronary artery,method of balloon inching dilatation could achieve high surgical successful rate,and the operation time and X-ray exposure time are reduced.To a certain extent,this method can reduce the cost of surgery.Application of balloon inching dilatation method is an effective method in treating CTO of coronary artery with safety and feasibility.The operation of PCI may cause certain myocardial reperfusion injury.