References

cardio

Кардиология

Kardiologiia

0022-90402412-5660

Kardiomag

10.18087/cardio.2019.2.10225

cardio-501

Research Article

ИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦА

ISCHEMIC HEART DISEASE

Опыт реканализации хронических окклюзий коронарных артерий с использованием современных эндоваскулярных методик

Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

Хелимский

Д. А.

Khelimskii

D. A.

Novosibirsk.

dkhelim@mail.ru

Крестьянинов

О. В.

Krestyaninov

O. V.

Novosibirsk.

Бадоян

А. Г.

Badoyan

A. G.

Novosibirsk.

Пономарев

Д. H.

Ponomarev

D. N.

Novosibirsk.

Покушалов

Е. А.

Pokushalov

E. A.

Novosibirsk.

ФГБУ «Национальный медицинский исследовательский центр им. акад. Е. Н. Мешалкина» Минздрава России.РоссияNational Medical Research Center named after acad. E. N. Meshalkin.Russian Federation

2019

07032019

5921016

2019

Kardiomag

https://cardio.elpub.ru/jour/about/submissions#copyrightNotice

https://cardio.elpub.ru/jour/article/view/501

Цель исследования. Оценка результатов чрескожных коронарных вмешательств (ЧКВ) с использованием современных стратегий реканализации при хронических окклюзиях коронарных артерий (ХОКА) у пациентов с ишемической болезнью сердца.Материалы и методы. В период с 2014 по 2016 г. было выполнено 477 ЧКВ при ХОКА у 456 пациентов. Средний возраст пациентов составил 59,9±7,1 года, 18,2 % женщин. Наиболее часто встречались окклюзии правой коронарной артерии (КА) – у 292 (61,2 %) пациентов, у 1 (0,2 %) пациента поражение локализовалось в стволе левой КА, передняя нисходящая и огибающая КА были поражены у 111 (23,2 %) и 73 (15,3 %) пациентов соответственно. Сложность окклюзии оценивалась по шкале J-CTO, согласно которой 30 % поражений классифицировались как простые, 36,4 % – промежуточные, 23,7 % – сложные и 18,9 % – очень сложные.Результаты. Технический и процедурный успех были достигнуты у 374 (78,4 %) и 366 (76,7 %) пациентов соответственно. Антеградная стратегия реканализации использовалась в 378 (79,2 %) случаях. Ретроградный подход применялся у 99 (20,7 %) пациентов, у 27 – в качестве первичной стратегии. У 469 (98,3 %) пациентов доступом для ЧКВ была выбрана лучевая артерия, а двойной доступ использовался у 147 (30,8 %). На госпитальном этапе не было зафиксировано летальных исходов, общая частота госпитальных осложнений составила 3,5 %. Среднее число стентов на 1 человека составило 1,6±0,98. Среднее время флюороскопии составляло 36,2±21 мин.Заключение. Частота развития осложнений, по данным нашего исследования, была сопоставима с результатами ЧКВ при неокклюзирующих поражениях коронарного русла. Однако, несмотря на большое количество ЧКВ по поводу ХОКА, показатели технического успеха уступают таковым в центрах со специализированными программами по ведению пациентов данной группы. Таким образом, требуется дальнейшая работа для преодоления этой разницы. Возможным решением данной проблемы может быть создание и внедрение в клиническую практику алгоритма реканализации ХОКА.

Purpose: to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.Materials and methods. We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.Results. Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.Conclusions. The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

хронические окклюзии коронарных артерийчрескожные коронарные вмешательствареканализациятехнический успех

chronic total occlusionpercutaneous coronary interventionrecanalizationtechnical success

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The authors declare that there are no conflicts of interest present.