经间隔支侧支循环作为逆行通路的逆向导丝技术治疗冠状动脉慢性完全闭塞病变的研究

Coronary septal collateral circulation as a retrograde approach in retrograde guidewire techniques for treatment of chronic total occlusion.

目的探讨间隔支形成的侧支循环经球囊扩张后作为逆向导丝技术通路治疗冠状动脉慢性完全闭塞病变(CTO)的可行性和安全性。方法南方医科大学附属珠江医院2007年6月至2008年8月19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慢性闭塞病变患者,通过经间隔支形成的侧支循环血管,在对侧使用亲水涂层尖端柔软的导丝逆行通过侧支循环到达闭塞病变远端时,小球囊低压力扩张侧支血管,完成CTO病变的介入治疗。2008年12月对上述患者进行随访(包括造影及电话随访),19例患者中男13例,女6例,平均年龄为(66.3±7.5)岁。结果 19例患者中18例经间隔支形成的侧支循环采用逆行导丝技术成功完成了闭塞血管的支架植入术,1例失败;所有患者无严重术中并发症,住院期间无死亡。术后随访4～16个月,手术失败患者和1例成功行逆向导丝技术开通右冠患者仍存在心绞痛症状;余17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 CTO经间隔支形成的侧支循环进行逆行导丝介入技术使手术成功率明显提高,并有良好的近期疗效。

Objective To investigate the feasibility and safety of balloon-dilated coronary septal collateral circulation as a retrograde approach for retrograde guidewire technique in treatment of coronary chronic total occlusions （CTOs）. Methods Nineteen CTO patients who failed routine antegrade CTO recanalization between June 2007 and August 2008 in our hospital were recruited in the study. The septal collateral was accessed via the contralateral patent coronary artery and was passed through with a hydrophilic floppy guidewire. After successful attempt, sequential low pressure dilatation was performed with a 1.25 or 1.5 mm balloon for interventional treatment of CTO lesions. In December 2008, a follow-up with imaging study and phone calls was conducted in the 19 patients （ comprising 13 males and 6 females, mean age ： 66. 3 ± 7.5 y/o）. Results Successful wire crossing and balloon dilation of septal collaterals was achieved in 18 cases. None of the patients experienced serious adverse events during procedure or died during the hospital stay. During the follow-up for 4 to 16 months, the patient who failed retrograde procedure and another who had successful operation still reported angina pectoris. The remaining 17 patients were followed by phone calls or clinic visits,with no angina peetoris or major cardiac events found a- mong them. Conclusion Coronary septal collaterals circulation used as an access for retrograde approach in the percutaneous treatment of CTOs can significantly improve the success rate of surgery and have favorable short-term outcomes.