磁导航导引系统在经皮冠脉介入治疗术中的初步应用

The initial application of magnetic navigation system in PCI

目的:明确磁导航导引系统在经皮冠脉介入治疗中的作用。方法:选取我院2005年3-8月择期经皮冠脉介入治疗患者86例,43例患者透视下以磁导航系统二维模式辅助调整磁导丝尖端的弯度和推送的方向,辅助导引导丝通过病变至靶血管的远端(磁导航组),其余43例患者以常规方法体外塑形导丝尖端和弯度,透视下手动旋转、推送导引钢丝通过靶病变至靶血管的远端(常规方法组)。两组患者均予球囊预扩张后植入支架。评价不同手术方法的两组患者导丝放置成功率、导丝放置时间、导丝放置X线曝光量、平均造影剂使用量。结果:(1)磁导航组41例(95.3%)患者在磁导航系统辅助下完成经皮冠脉介入治疗,2例因磁导航导丝进入冠脉内膜下假腔换用常规导丝完成手术,无死亡,无心血管事件。(2)磁导航组病变通过时间、放射透视剂量均高于常规方法组,但造影剂使用量低于常规方法组。结论:磁导航导引系统在经皮冠脉支架植入术中是安全、有效的,但是仍需经过一个学习曲线。

Objective To evaluate the application of magnetic navigation system （MNS） in percutaneous coronary intervention （PCI）. Methods Eighty-six patients admitted from March to August in 2005 with selected PCI were enrolled, the magnetic navigation system was used in 43 cases （MNS group）, in which the advance of magnetic guidewire was regulated hy 2D mode of MNS to the target vessels. Another 43 cases （control group） received the conventional method for PCI. Then patients in both groups received the pre-dilation and stent implantation. The crossing success rate, fluoroscopy time to cross lesion, contrast volume were assessed, respectively. Results Forty-one （95.3%） cases in MNS group were successfully administered with PCI procedure. The magnetic guidewire had to be replaced by the conventional wire for the intimium dissection of artery caused by magnetic navigation wire in 2 patients with long and diffused stenosis lesion. No wire perforations occurred in this group. The fluoroscopy time to cross lesion and the wire crossing time of MNS group were more than those of control group. The contrast volume in MNS group was significantly lower than that in control groups. Conclusion The MNS is safe and effective in PCI procedure. A learning curve with more cases and learning time, however, should be needed.