Background:Multiple crossing techniques in chronic total occlusion (CTO) percutaneous coronary intervention have been developed. This study compared recovery of quantitative myocardial blood flow (MBF) after different CTO percutaneous coronary intervention techniques.Methods:Consecutive patients with [¹⁵O]H₂O positron emission tomography perfusion imaging before and 3 months after successful CTO percutaneous coronary intervention between 2013 and 2018 were included. Changes in hyperemic MBF, coronary flow reserve, and perfusion defect size were compared between antegrade wire escalation, retrograde wire escalation, antegrade dissection and reentry (ADR), and retrograde dissection and reentry.Results:One hundred ninety-three patients were treated with antegrade wire escalation (N=90), retrograde wire escalation (N=24), ADR (N=35), and retrograde dissection and reentry (N=44). Increase in hyperemic MBF (1.19±0.77, 0.94±0.65, 1.09±0.63, and 1.02±0.75 mL·min^-1·g^-1, respectively; P=0.40) and coronary flow reserve (1.34±1.08, 1.14±1.09, 1.31±0.96, and 1.24±0.99, respectively; P=0.84) and decrease in defect size (3.2±2.1, 3.0±2.2, 2.7±2.1, and 2.9±1.9 segments, respectively; P=0.77) were comparable between the 4 approaches. In addition, recovery of hyperemic MBF was less pronounced after subintimal crossing with knuckle-wire-technique compared with CrossBoss in controlled ADR and retrograde dissection and reentry (0.93±0.69 versus 1.54±0.65 mL·min^-1·g^-1, P=0.02), and less after reentry using subintimal tracking and reentry in ADR compared with controlled ADR (Stingray) or limited antegrade subintimal tracking (0.60±0.53 versus 1.18±0.54 [P=0.04] and versus 1.49±0.57 mL·min^-1·g^-1, [P<0.01]).Conclusions:Recovery of hyperemic MBF, coronary flow reserve, and perfusion defect size after CTO percutaneous coronary intervention was comparable between different approaches. Although sometimes necessary to cross a complex CTO lesion, subintimal knuckle wiring and subintimal tracking and reentry resulted in less hyperemic MBF improvement compared with other subintimal crossing and reentry techniques.

中文翻译：

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慢性完全闭塞经皮冠状动脉介入治疗中特定交叉技术对绝对心肌灌注恢复的影响。

背景：在慢性总闭塞（CTO）经皮冠状动脉介入治疗中已开发出多种交叉技术。这项研究比较了不同的CTO经皮冠状动脉介入治疗技术后定量心肌血流（MBF）的恢复。方法：连续性[ ¹⁵ O] H _2的患者包括2013年至2018年成功进行CTO经皮冠状动脉介入治疗之前和之后三个月的O型正电子发射断层扫描灌注成像。比较了顺行钢丝升级，逆行钢丝升级，顺行解剖和折返（ADR）和逆行解剖和折返之间充血性MBF，冠状动脉血流储备和灌注缺损大小的变化。结果：193例患者接受了顺行治疗导线升级（N = 90），导线逆行升级（N = 24），ADR（N = 35）以及逆行解剖和折返（N = 44）。充血性MBF的升高分别为（1.19±0.77、0.94±0.65、1.09±0.63和1.02±0.75 mL·min ^-1 ·g ^-1 ; P= 0.40）和冠状动脉血流储备（分别为1.34±1.08、1.14±1.09、1.31±0.96和1.24±0.99; P = 0.84）并减少缺损尺寸（3.2±2.1、3.0±2.2、2.7±2.1和四种方法之间的差异分别为2.9±1.9；P = 0.77）。此外，在控制的ADR和逆行性解剖及折返中，用节线技术在内膜下交叉后充血性MBF的恢复不如CrossBoss显着（0.93±0.69 vs 1.54±0.65 mL·min ^-1 ·g ^-1，P = 0.02），与使用受控ADR（Stingray）或有限顺行亚内膜追踪相比，使用亚内膜追踪和再进入ADR再进入后的次数更少（0.60±0.53对1.18±0.54 [ P= 0.04]与1.49±0.57 mL·min ^-1 ·g ^-1相比，[ P <0.01]）。 。尽管有时需要穿越复杂的CTO病变，但与其他内膜下穿越和折返技术相比，内膜下关节连接以及亚内膜追踪和折返导致的充血性MBF改善较少。