郭鹏 刘日辉 张晓娇 王永 栾波

【摘要】 目的：觀察逆向导丝穿刺正向扩张球囊技术（BIRD）治疗冠状动脉慢性完全性闭塞性病变（CTO）效果及安全性。方法：选取辽宁省人民医院2017年1月-2018年2月逆向PCI成功开通CTO患者60例，其中行传统正向操控导丝及逆向导丝内膜下寻径技术（CART）28例设为CART组，行BIRD的32例设为BIRD组，比较两组冠脉造影情况及介入手术相关指标。结果：两组患者的J-CTO评分、病变血管情况、靶血管情况、侧支血管情况比较，差异均无统计学意义（P>0.05）。CART组X线曝光时间长于BIRD组，曝光剂量高于BIRD组，对比剂用量、逆向导丝数目均多于BIRD组，差异均有统计学意义（P<0.05）。两组术中靶血管夹层、侧支血肿生率比较，差异均无统计学意义（P>0.05）。两组术后30 d均未发生MACE。结论：与传统CART术相比，BIRD术在逆向开通CTO病变的同时，减少了X线曝光时间及曝光剂量，降低了术中对比剂用量，并减少了逆向导丝的应用数量;在安全性方面，并未增加手术相关并发症。

【关键词】 正向操控导丝及逆向内膜下寻径技术 逆向导丝穿刺正向扩张球囊术 慢性完全性闭塞性病变 经皮冠脉血管成形术

Application of Balloon Inflated Retrograde Wire Deep-going Technique in Revascularization of Coronary Chronic Total Occlusion/GUO Peng， LIU Rihui， ZHANG Xiaojiao， WANG Yong， LUAN Bo. //Medical Innovation of China， 2021， 18（33）： 061-065

[Abstract] Objective： To observe the efficiency and safety of balloon inflated retrograde wire deep-going technique （BIRD） during recanalization in the treatment of coronary chronic total occlusion （CTO）. Method： A total of 60 patients with CTO successfully opened in People’s Hospital of Liaoning Province from January 2017 to February 2018 were included， including 28 patients who underwent traditional controlled antegrade and retrograde subintimal tracking （CART） as CART group， and 32 patients who underwent BIRD technique as BIRD group. The coronary angiography and related indexes of interventional surgery were compared between the two groups. Result： There were no statistically significant differences in J-CTO score， pathological vessels， target vessels and collateral vessels between the two groups （P>0.05）. The X-ray exposure time of CART group was longer than that of BIRD group， and the exposure dose was higher than that of BIRD group， the amount of contrast media and the number of reverse guide wire were higher than those in BIRD group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in incidence of intraoperative target vessel dissection and collateral hematoma between the two groups （P>0.05）. No MACE occurred in both groups 30 d after operation. Conclusion： Compared with traditional CART， the BIRD technique can reverse open CTO lesions， reduce X-ray exposure time and exposure dose， reduce the amount of intraoperative contrast media， and reduce the application number of reverse guide wire; in terms of safety， it does not increase the incidence of surgery related complications.

[Key words] Controlled antegrade and retrograde subintimal tracking Balloon inflated retrograde wire deep-going technique Chronic total occlusion Percutaneous coronary angioplasty

First-author’s address： Liaoyang City Central Hospital， Liaoyang 111000， China

doi：10.3969/j.issn.1674-4985.2021.33.016

冠状动脉慢性完全性闭塞性病变（chronic total occlusion，CTO）的开通是冠脉介入手术治疗领域最后的高地[1-3]。正向开通CTO手术失败的原因集中于正向导丝无法穿透近段的钙化纤维帽进入远端的血管真腔[4]。近年来随着逆向导丝技术及器械的发展，CTO的开通率由60%～70%提高至92%[5-6]。其中正向操控导丝及逆向导丝内膜下寻径技术（controlled antegrade and retrograde subintimal tracking，CART）成为CTO术者的利器之一[7]。但CART技术对CTO术者导丝操控及经验有着极高的要求[8]。……