逆向开通冠状动脉慢性完全性闭塞病变中预塑型导丝的应用

The efficiency and safety of pre-shaped guide wires applied in retrograde complex chronic total occlusion of coronary arteries

目的:探讨预塑型导丝在逆向开通复杂冠状动脉慢性完全性闭塞性病变(CTO)中通过侧支循环及闭塞段的有效性及安全性。方法:入选18例因血管条件不佳或闭塞段较长正向开通CTO病变失败的患者。分别穿刺双侧股动脉,植入7F鞘管,正向指引导管内采用Runthrough导丝携带130cm微导管于闭塞段处备用,逆向指引导管内采用Runthrough导丝携带150cm微导管至侧支循环内,藉由逆向微导管,分别采用普通软导丝或SION black预塑型导丝尝试通过侧支循环,直至进入靶血管远段真腔内,前送逆向微导管至闭塞段,分别交换为普通硬导丝或Gaia系列预塑型导丝直至成功逆向通过CTO闭塞段,采用微导管对接技术或内膜下寻径技术(CART),促使正向Runthrough导丝至CTO远段真腔内,后续球囊扩张后植入支架,完成经皮冠状动脉介入治疗术(PCI)。结果:在18例患者中,SION black及Gaia预塑型导丝表现出良好的通过侧支循环及穿刺闭塞段的能力,减少了手术及曝光时间,术后患者无心包填塞、恶性心律失常等并发症的发生。结论:SION black及Gaia系列预塑型导丝与非预塑型导丝相比,在通过侧支循环所用时间及闭塞段通过率上均有优异的表现,且具有良好的安全性,应广泛应用于今后逆向开通CTO病变的PCI手术中。

Objective：To assess the efficiency and safety of application via pre-shaped guide wires in retrograde recanalization of complex of chronic total occlusion（CTO）.Method：Retrograde percutaneous coronary intervention（PCI）via collateral circulation was performed in 18 patients,whose antegrade PCI failed previously.Double7 Fguiding catheters were engaged in left and right femoral arteries.The Runthrough guide wires carrying microcatheters were separately put into the antegrade and retrograde guiding catheters.Then the retro-Runthrough was separately exchanged into the common SION or SION black pre-shaped guide wire,until crossed the collateral circulation to end of the true lesion of target vessel.With Putting forward the microcatheter,common hard guide wires or Gaia series pre-shaped guide wires were then separately exchanged into the retro-microcatheter and retropunctured the CTO lesion.Eventually the guide wires went into the ante-guiding catheter by CART and microcatheter kissing techniques,furthermore the ante-Runthrough guide wire arrived at the distal true lesion of CTO and recanalized by conventional PCI method.Result：The pre-shaped guide wires showed excellent abilities of crossing the collateral circulations and occlusion lesions in the recanalization of CTO with no serious complications.Conclusion：The pre-shaped guide wires are proved safe and efficient in the retrograde CTO PCI,they are deserved to apply to further clinical works.