分支导丝技术在治疗冠状动脉慢性闭塞性病变中的应用

Application of side branch wire technique in therapy of coronary chronic total occlusion lesions

目的探讨分支导丝技术在治疗冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变中应用的效果。方法回顾性分析136例经冠状动脉造影证实CTO病变位于血管弯曲部位且闭塞段为长病变患者的临床资料,着重分析其采取分支导丝技术行经皮冠状动脉介入治疗的方法和效果。结果共对136例单支冠状动脉CTO病变的靶血管进行了冠状动脉介入治疗。所有冠状动脉介入治疗的第一根导丝均进入分支血管,125例第二根导丝进入主支血管,11例导丝无法通过闭塞病变进入主支血管,4例球囊无法通过闭塞病变;共植入支架176枚;血管开通121例,心肌梗死溶栓试验血流达到3级,成功率89%。1例患者术中出现夹层,1例发生血管穿孔;所有患者住院期间无死亡。结论 CTO介入治疗根据其病变影像学特征,严格筛选患者,采取分支导丝技术能提高手术成功率且安全有效。

Objectives To investigate the application of side branch technique in interventional therapy of coronary chronic total occlusion（CTO）.Methods We retrospectively analyzed the clinical data of 136 patients with CTO,focusing on methods and results of side branch technique in interventional therapy of CTO.Coronary angiography showed that all the CTO lesion length exceed 15 mm and position located at vascular bent part in all patients.Results Percutaneous coronary intervention（PCI） were performed on the CTO lesion in 136 patients.The first guide wires were involved in the branch vessel in all patients.The other wires were through the CTO into distal true lumen in 125 patients,but the small balloon could not passed through the occlusion in 4 patients.The surgical success rate was 89.0%.Coronary dissection appeared in 1 patient and vessel perforation occurred in 1 cases.No patient died during hospitalization.Conclusions According to the CTO＇s angiogram characteristics,strictly selecting cases to take side branch technique in interventional can significantly improved the PCI success rate.Side branch technique is useful and safety in CTO intervention.