医学
传统PCI
经皮冠状动脉介入治疗
心脏病学
内科学
部分流量储备
血流
冠状动脉循环
血管阻力
冠状动脉血流储备
动脉
血流动力学
心肌梗塞
冠状动脉造影
作者
Sarosh Khan,Osama Alsanjari,Daniëlle C J Keulards,Pieter J. Vlaar,Jufen Zhang,Klio Konstantinou,Samer Fawaz,Rupert Simpson,Gerald J. Clesham,Paul A. Kelly,Kare Tang,Christopher Cook,James Cockburn,Nico H.J. Pijls,David Hildick‐Smith,Koen Teeuwen,Thomas R. Keeble,Grigoris V. Karamasis,John R. Davies
出处
期刊:Eurointervention
[Europa Digital and Publishing]
日期:2023-06-01
卷期号:19 (2): e123-e133
被引量:2
标识
DOI:10.4244/eij-d-22-00694
摘要
Randomised studies of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) have shown inconsistent outcomes, suggesting incomplete understanding of this cohort and their coronary physiology. To address this shortcoming, we designed a prospective observational study to measure the recovery of absolute coronary blood flow following successful CTO PCI Aims: We sought to identify patient and procedural characteristics associated with a favourable physiological outcome after CTO PCI.Consecutive patients with a CTO subtending viable myocardium underwent PCI utilising contemporary techniques and the hybrid algorithm. Immediately after PCI, and at 3-month follow-up, physiological measurements were performed utilising continuous thermodilution.A total of 81 patients were included with a mean age of 63.6±8.9 years, and 66 (81.5%) were male. Physiological measurements of absolute coronary blood flow in the CTO vessel increased by 30% (p<0.001) and microvascular resistance reduced by 16% (p<0.001) from immediately post-CTO PCI to follow-up assessment. Fractional flow reserve increased by 0.02 (p=0.015) in the same period. Prior coronary artery bypass graft (CABG) and a higher estimated glomerular filtration rate (eGFR) were associated with a larger change in absolute flow. An extraplaque strategy was associated with a smaller change in absolute flow.Post-CTO PCI, there is a continued augmentation in absolute coronary blood flow and reduction in microvascular resistance from baseline to follow-up at 3 months. Prior CABG and a higher baseline eGFR were predictors of a larger change in absolute coronary flow, whilst an extraplaque final wire path strategy predicted a smaller change. Lastly, the patient characteristics and comorbidities had a larger influence than procedural factors on the observed change in absolute flow.
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