vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"vestim-387Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEВРЕМЕННЫЕ ТЕНДЕНЦИИ УСПЕШНОЙ РЕКАНАЛИЗАЦИИ ХРОНИЧЕСКИХ ТОТАЛЬНЫХ ОККЛЮЗИЙ КОРОНАРНЫХ АРТЕРИЙ АНТЕГРАДНЫМ ДОСТУПОМ И РИСКА РАЗВИТИЯ КАРДИАЛЬНЫХ ОСЛОЖНЕНИЙTEMPORARY TRENDS OF SUCCESS RATE AND CARDIAC COMPLICATION RISK IN CHRONIC TOTAL OCCLUSION RECANALIZATION BY THE ANTEGRADE APPROACHСтельмашокВ. И.StelmashokV. I.

канд. мед. наук, доцент, заведующий лабораторией

Ph. D. (Med.), Assistant Professor, Head of the Laboratory

stelval@yandex.ruРеспубликанский научно-практический центр «Кардиология»National Scientific and Practical Centre “Cardiology”201708102017037281Copyright © Стельмашок В.И., 20172017Стельмашок В.И.Stelmashok V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/387

Изучены временные тенденции успешной реканализации хронических тотальных окклюзий (ХТО) коронарных артерий антеградным доступом и риска развития кардиальных осложнений. С 2009 по 2013 г. попытка реканализации ХТО коронарных артерий антеградным доступом была предпринята у 217 пациентов. Обследуемые были разделены на две группы: группа 1 (n = 158) – успешно выполненная реканализация, группа 2 (n = 59) – неуспешная реканализация. К концу периода наблюдения увеличилось число пациентов с более сложным клиническим профилем и комплексной рентгенморфологией окклюзионного поражения, наряду с этим отмечалась тенденция к увеличению количества успешно выполненных реканализаций ХТО. Наблюдаемые в указанный период тенденции к увеличению случаев успешной реканализации и удачного проведения коронарного проводника обусловлены изменением стратегии реканализации, а именно изменением принципа выбора коронарного проводника, характера и последовательности его использования. Частота кардиальных осложнений оставалась стабильной на протяжении всего периода наблюдения и варьировалась от 11,3 % в 2012 г. до 36,6 % в 2011 г. «Больших осложнений» (летального исхода, острого инфаркта миокарда, потребности в выполнении экстренной операции коронарного шунтирования), развития тампонады сердца и потребности в выполнении дренирования перикарда не отмечалось. По мере накопления опыта попытка реканализации ХТО коронарных артерий предпринималась у пациентов с более сложными формами поражения. При этом прослеживалась тенденция к увеличению случаев успешного вмешательства, без изменения риска развития кардиальных осложнений.

 

Temporary trends of success rate and cardiac complication risk in chronic total occlusion (CTO) recanalization by the antegrade approach are studied. From 2009 to 2013, the attempt of coronary artery CTO recanalization by the antegrade approach was undertaken for 217 patients. Depending on the success of CTO recanalization, patients were divided into 2 groups: group 1 (n = 158) – successful procedure, group 2 (n = 59) – unsuccessful attempt of CTO recanalization. By the end of the observation period, the number of patients with more difficult clinical profile and a complex CTO morphology increased, but the CTO recanalization success rate frequency also had a positive tendency. Observed tendencies to increase a general success recanalization rate and the success of CTO recanalization by coronary wire were caused by changes in the recanalization strategy which occurred during the time from 2009 to 2013, including the change of the coronary wire principle of choice, character and sequence of its use. 5 The frequency of a cardiac complication rate remained stable throughout the entire period of observation and varied from 11.3 % in 2012 to 36.6 % in 2011. «Major complications» (death, acute myocardial infarction, emergency coronary artery bypass grafting), the development of cardiac tamponade and pericardium drainage cases were not seen in the current study. In the process of operators experience accumulation, an attempt of CTO recanalization was made in more difficult patients; at the same time, the positive tendency to recanalization success was observed, without any noticeable changes in risk of cardiac complications.

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