| Objectives:Chronic total occlusion(CTO)refers to the complete occlusion of the coronary artery with forward blood flow TIMI0 showed by coronary angiography,and the occlusion time may be greater than 3 months depending on the history of illness or the operator's experience.The difficulty of opening the CTO lesion by the intervention method is high,the immediate success rate is low,and the postoperative restenosis rate is high,and is still a difficult problem in the field of PCI.In recent years,with the intervention technology has been further developed,especially after the reverse technique has been widely used,the success rate of CTO operation has been obviously improved.The difference of successful rate of operation is due to the difference of the technical level of the interventional doctor and the equipment of the catheterization room,as well as the difference in the choice of interve-ntional therapy strategy of CTO.Different physicians will adopt different CTO intervention strategies according to their personal judgment,but because of the different anatomy and pathological structure of CTO lesions,each technique has its limitations.Especially,the balloon or microcatheter could not pass through the CTO lesion because of the serious calcification and tortuous angulation of the lesion after the guide wire was passed,which often caused the operation to be helpless.When the guide wire passes through the occluded segment of the CTO and the internal pathological structure of the lesion prevents the balloon or microcatheter from passing through the lesion,the common strategy is to replace the device to enhance the support of the catheter and so on.Rotational atherectomy is also an effective choice for this kind of lesion,but because the balloon or microcatheter cannot pass through the occlusive lesion,it is impossible to exchange the rotation guide wire,only to send the rotation guide wire through the occlusive lesion to the distal end.Therefore,the failure to send the wire to the distal end of the occlusive lesion often leads to the abandonment.The Tornus(Japan,Asahi)catheter is a catheter used to guide wires through balloon catheters or microcatheters that cannot pass through severe stenosis and CTO lesions.It is necessary to avoid improper rotation causing the catheter to break in the coronary artery.Even some CTO lesions do not pass through the Tornus catheter.Parallel guidewire technique is that when the balloon or stent is difficult to pass through the lesion or dilated lesion,two guide wires are inserted into the distal end of the CTO lesion to provide the orbit for the balloon or stent to pass through the lesion,thus increasing the support force and straightening the lesion.Prevent balloon slide,cut calcification lesions and other effects.The core of multi-wire crushing technique is that after the guide wire crushing through the occlusive lesion,the loose structure of the plaque are changed and even the enlargement of the lumen are happened,and the exit of the guide wire is beneficial to the passage of the balloon.If the internal structure of CTO lesions is hard,and because of insufficient support force,the guide wire of parallel wire guide technology and multi-wire crushing technology is easy to enter the subintimal cavity and even perforate.Crusade double-lumen microcatheter(Japan,Kaneka)is initially used for forked lesions to ensure the coaxial property of guide wire,can be used to exchange guide wire to further strengthen the penetration force of guide wire,and can also be used to guide the direction of guide wire and realize precise puncture.On this basis,Professor Yu Lei-sheng took the lead in improving the multi-wire crushing technology of academician Han Yaling in China,and carried out multi-wire crushing technology with the aid of double-lumen microcatheter.The purpose of this study was to observe the efficacy and safety of modified multi-wire plaque crushing technique assisted by Crusade double-lumen microcatheters for PCI in CTO lesions which the guide wire was passed through but the balloon could not pass through.Method:1 Study population:60 patients who met the criteria of inclusion were enrolled in the Department of Cardiovascular Medicine of the 980th Hospital of the Joint Logistics support Force from 2016/9/1to2018/3/31.2 Selection criteria:Patients who were identified as CTO lesions by coronary angiography and underwent PCI at the same time in the CTO vessels.During the operation,When the guide wire reached the distal true cavity through the occlusive segment of the CTO lesion and after trying repeatedly the minimal microcatheter or balloon was not able to pass through the CTO lesion,a double-lumen microcatheter was used for multi-wire plaque crushing.3 research technique3.1 The basic information of the patients was collected by using the inpatient case system of the 980th hospital of the Joint Logistics support Force,inclu-ding age,sex,history of diabetes,hypertension,myocardial infarction,family history of coronary heart disease,smoking,and preoperative echocardio-graphic left ventricular ejection fraction(LVEF),serum creatinine,cholesterol,low density lipoprotein(LDL),etc.3.2 The features of CTO lesions in coronary angiography were collected,including the location of CTO lesions and the features of each CTO lesion.J-SCORE score was used to determine whether the CTO lesions were calcified,whether the length was more than 20 mm,and whether the shape of the CTO segment was tortuous and the angle was more than 45~o.Whether or not the proximal lesion of occlusive segment is blunt stump or no stump,and whether there are previous failed PCI experiences,etc.The J-CTO score was calculated and compared with other CTO patients with PCI during the same period.Take notes the operation time,dosage of contrast agent,technical success rate and surgical success rate and complications(Including perforation,pericardial packing,non-reflow,etc.),the type of crushing guide wire,crushing times and the balloon we used after crushing.3.3 Collecting patients'severe cardiovascular events during hospitalization and telephone follow-up at 1,6 months after discharge.Serious cardiov-ascular adverse events include:cardiogenic death,target vessels innervate myocardial infarction(ST segment elevation and non-ST segment elevation myocardial infarction)and target vessels are revascularized again(PCI or coronary artery bypass grafting).4 Statistical analysisThe statistical analysis was carried out with SPSS 21.0 software system.The measurement data were expressed as meanąstandard deviation or median(quartile spacing).T test(normal distribution)or Mann Whitney U test(non-normal distribution)were used to compare the two groups.The count data is expressed in frequency or rate.The chi-square test was used to compare the two kinds of variables,and the Fisher exact probability method was used for theoretical frequency<5.All the statistical analysis were carried out by two-tialed test,P<0.05 as the difference was statistically significant.Result:A total of 60 CTO treated with double-lumen microcatheter-assisted multi-wire plaque crushing technique were selected.Compared with other 220 CTO lesions in the same period,the proportion of severe calcified lesions,obtuse stump or non-stump lesions,J-CTO score?2,J-CTO score?3 was significantly higher.In this study,60 patients were treated with double-lumen microcatheter assisted multi-wire crushing technique,93.33%of which were successfully passed through balloon,and 2 cases had complications during the operation of the new technique.Conclusion:The double-lumen microcatheter assisted multi-wire plaque crushing technique is an effective,relatively safe and high successful technique In the process of CTO-PCI,when the guide wire is passes through the occluded segment and the smallest balloon or microcatheter is unable to pass through. |
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