论文部分内容阅读
目的:探讨预塑型导丝在逆向开通复杂冠状动脉慢性完全性闭塞性病变(CTO)中通过侧支循环及闭塞段的有效性及安全性。方法:入选18例因血管条件不佳或闭塞段较长正向开通CTO病变失败的患者。分别穿刺双侧股动脉,植入7F鞘管,正向指引导管内采用Runthrough导丝携带130cm微导管于闭塞段处备用,逆向指引导管内采用Runthrough导丝携带150cm微导管至侧支循环内,藉由逆向微导管,分别采用普通软导丝或SION black预塑型导丝尝试通过侧支循环,直至进入靶血管远段真腔内,前送逆向微导管至闭塞段,分别交换为普通硬导丝或Gaia系列预塑型导丝直至成功逆向通过CTO闭塞段,采用微导管对接技术或内膜下寻径技术(CART),促使正向Runthrough导丝至CTO远段真腔内,后续球囊扩张后植入支架,完成经皮冠状动脉介入治疗术(PCI)。结果:在18例患者中,SION black及Gaia预塑型导丝表现出良好的通过侧支循环及穿刺闭塞段的能力,减少了手术及曝光时间,术后患者无心包填塞、恶性心律失常等并发症的发生。结论:SION black及Gaia系列预塑型导丝与非预塑型导丝相比,在通过侧支循环所用时间及闭塞段通过率上均有优异的表现,且具有良好的安全性,应广泛应用于今后逆向开通CTO病变的PCI手术中。
Objective: To investigate the effectiveness and safety of the preformed guidewire in collateral circulation and occlusion in the reverse complicated coronary artery with chronic total occlusive disease (CTO). Methods: Eighteen patients with failed CTO lesions due to poor vascular conditions or long occlusion were enrolled. The bilateral femoral arteries were punctured respectively and the 7F sheath was implanted. The Runthrough guidewire was used to carry the 130cm microcatheter in the positive guide catheter. The reverse guide catheter was used to carry the 150cm microcatheter into the collateral circulation with Runthrough guidewire. By reverse microcatheter, respectively, the use of ordinary soft guide wire or SION black preformed guidewire through the collateral circulation, until the target vessel into the true cavity of the distal segment, before sending reverse microcatheter to the occlusion segment, were exchanged for ordinary hard The guidewire or Gaia series of preformed guidewire until successful reversal through the CTO occlusion segment, the use of microcatheter docking technology or subtotal aspiration (CART), to promote the positive Runthrough guidewire to the CTO distal true cavity, follow-up ball The balloon is expanded and implanted into the stent to complete percutaneous coronary intervention (PCI). RESULTS: In 18 patients, the SION black and Gaia preformed guidewires showed good ability to pass collateral circulation and puncture occlusion, which reduced the operation and exposure time, and had no cardiac tamponade and malignant arrhythmia after operation Complications occur. CONCLUSIONS: Compared with non-preformed guidewire, the SION black and Gaia series of preformed guidewires have excellent performance over the passage of collateral circulation and occlusion segment, and have good safety and should be widely used Used in the future reverse CTO lesions in PCI surgery.