逆向导丝技术治疗冠状动脉慢性完全闭塞病变的可行性

Feasibility and safety of retrograde wire technique for the treatment of chronic coronary artery occlusion

目的探讨逆向导丝技术治疗冠状动脉慢性完全闭塞病变的可行性和安全性。方法对13例常规前向导丝技术行经皮冠状动脉腔内支架置入术失败的冠状动脉慢性闭塞病变患者采取逆向导丝技术行冠脉内支架置入患者进行随访,包括造影及电话随访。结果手术即刻成功率92.3%,无严重术中并发症,住院期间无死亡。术后随访3～12个月,1例手术失败患者仍存在心绞痛症状,1例手术成功患者术后3个月出现心绞痛症状,行冠状动脉造影检查,显示支架内再狭窄;余11例均进行了经电话和临床随访,无心绞痛及心血管主要临床事件发生。结论对于不能通过正向导丝技术完成的病变,采用逆向导丝技术可使手术成功率明显提高,对经过严格选择的CTO患者进行逆行导丝介入技术是可行和安全的,并有良好的近期疗效。

Objective To investigate the feasibility and safety of retrograde wire technique for the treatment of chronic coronary artery occlusion. Methods Thirteen patients with chronic coronary artery occlusion who received coronary artery inner bracket operations by retrograde wire technique following failure of routine transcutaneous antegrade wire technique were followed up from April, 2008 by angiography and on telephone. There were 11 male and 2 female patients, with a mean age of 62.3 ± 7.7. Results The instant success rate of operations was 92.3% , and no severe complications or death occurred during hospital stay. Follow - up for 6 to 12 months after operation revealed that 1 patient failed in oper- ation had symptoms of angina, and according to the coronary arteriongraphy, restenosis in braket occurred in 1 patient with success operation who had symptoms of angina 3 months after operation. No angina or major cardiovascular events happened. Conclusion Retrograde wire technique significantly increases the success rate of procedure in patients who failed in antegrade wire technique. It is feasible and safe to perform retrograde wire technique in selected CTO patients with adequate short term outcome.