正向导管内锚定法经逆向导丝技术开通右冠状动脉慢性闭塞性病变一例

Antegrade Anchoring Technique in Antitrade Guiding Catheter while Rechanneling the Right Coronary Chronic Total Occluded Artery by Retrograde Wire Technique

目的探讨正向导管内锚定法经逆向导丝技术开通右冠状动脉慢性闭塞性病变的效果。方法回顾分析1例正向导管内锚定法经逆向导丝技术开通右冠状动脉闭塞的治疗经过。患者出现间断胸痛3年,行冠状动脉造影可见左向右三级侧支循环,右冠状动脉中段以远完全闭塞。多次尝试正向开通右冠状动脉不能成功,考虑患者侧支循环建立较好,试行逆向开通右冠状动脉。由于间隔支不能通过,最终选择心外膜侧支,导丝通过闭塞病变后进入主动脉窦,但是逆向球囊送入困难,采用正向导管内球囊锚定法,操控逆向导丝进入正向导管内,并在导管内扩张球囊锚定逆向导丝以利于球囊通过。结果造影见右冠状动脉显影,正向送入WHISPER导丝成功到达右冠状动脉远端,反复扩张病变处,植入3枚药物涂层支架,慢性闭塞的右冠状动脉开通成功。术后6个月随访,无心绞痛等心血管事件发生。结论慢性完全性闭塞(chronic total occlusion,CTO)病变介入治疗的手术成功率低,逆向导丝技术的出现明显提高了CTO病变导丝通过成功率。

Objective To investigate the effect of anchoring technique in antitrade guiding catheter while rechanneling the right coronary chronic total occluded artery by retrograde wire technique.Methods A case of chronic total occluded RCA lesion rechanneled by retrograde wire technique and anchoring technique in antegrade guiding catheter was retrospectively analyzed.The patient suffered from chest pains fro 3 years and his RCA was total occluded but developed very good collateral circulation from left coronary artery.We changed to retrograde after failure to open the CTO vessel from antegrade guiding catheter as routines.The wire successfully passed into occluded RCA from left coronary artery through epicardial collateral vessel and advanced to aortic sinus,but the balloon catheter advance was difficult from retrograde.We carefully adjusted the retrograde wire into RCA guiding catheter,then anchored it with a balloon,while the retrograde balloon catheter was advanced to RCA occluded site and dilated.Results Finally the RCA was successfully reopened after three stents were set in.No angina and other cardiovascular events occurred during the 6-month follow-up.Conclusion The recanalization of CTO leisions is associated with lower success rate and high rate of complications and restenosis.The main reason is failure of wire advancing,while retrograde wire technique can improve the success rate.