BackgroundIntraplaque delivery of contrast has been utilized during percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) to delineate anatomy and to facilitate wire crossing. Its utility as a tool to accomplish primary crossing of CTOs has not been described or validated.AimsWe describe a new technique leveraging the diagnostic and therapeutic roles of intraplaque contrast injection to accomplish primary crossing of CTOs: HydroDynamic contrast Recanalization (HDR).MethodsHDR is an antegrade crossing method for coronary CTOs based on the synergistic use of contrast microinjections and polymer jacketed wires. We present a retrospective, first‐in‐man, case series utilizing HDR for CTO PCI in patients with favorable CTO anatomy (visible proximal segment and identifiable distal target). The primary outcome was procedural success. The secondary outcome was any procedural complications.ResultsA total of 43 patients with 45 CTOs underwent CTO PCI with HDR. Mean patient age was 64.3 ± 11 years. The mean Japanese CTO and PROGRESS CTO scores were 2.3 ± 0.7 and 1.8 ± 0.7, respectively. CTO complexity was high, with an ambiguous or blunt cap in 34 occlusions (76%); lesion length ≥ 20 mm in 27 occlusions (60%); and moderate/heavy calcification in 36 occlusions (80%). Procedural success using HDR was 100%. There were no complications.ConclusionsThis study shows the utility of HDR in CTO PCI. HDR appears to be a safe and promising new contrast‐based primary crossing technique in selected patients. This strategy warrants further evaluation in larger prospective studies.

中文翻译：

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水动力对比再通 (HDR)：冠状动脉慢性完全闭塞的新交叉技术的描述


背景 在慢性完全闭塞 (CTO) 的经皮冠状动脉介入治疗 (PCI) 过程中，斑块内输送造影剂已被用来描绘解剖结构并促进导线交叉。它作为完成 CTO 初次交叉的工具的实用性尚未得到描述或验证。目的我们描述了一种利用斑块内造影剂注射的诊断和治疗作用来完成 CTO 初次交叉的新技术：水动力造影剂再通 (HDR)。基于对比显微注射和聚合物护套线协同使用的冠状动脉 CTO 顺行穿越方法。我们提出了一个回顾性、首次人体病例系列，利用 HDR 对具有良好 CTO 解剖结构（可见近端节段和可识别远端目标）的患者进行 CTO PCI。主要结果是程序成功。次要结局是任何手术并发症。结果共有 43 名患者的 45 名 CTO 接受了 HDR 的 CTO PCI。患者平均年龄为 64.3 ± 11 岁。日本 CTO 和 PROGRESS CTO 的平均得分分别为 2.3 ± 0.7 和 1.8 ± 0.7。 CTO 复杂性很高，有 34 个遮挡 (76%) 的上限不明确或生硬； 27 个闭塞处病变长度≥ 20 毫米（60%）； 36 个闭塞处（80%）有中度/重度钙化。使用 HDR 的程序成功率为 100%。没有出现并发症。结论本研究显示了 HDR 在 CTO PCI 中的实用性。对于选定的患者来说，HDR 似乎是一种安全且有前景的新型基于对比的初次交叉技术。该策略值得在更大规模的前瞻性研究中进行进一步评估。