双腔微导管在合并分叉病变的冠状动脉慢性完全闭塞病变行经皮冠状动脉介入治疗中的作用

Use of double lumen microcatheter in interventional treatment of chronic total occlusion lesions at bifurcation

目的评价双腔微导管在经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中处理合并分叉病变的冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)的有效性与安全性。方法回顾性分析2013年10月至2015年3月于白求恩国际和平医院心内科应用双腔微导管处理合并分叉病变的CTO患者23例。收集患者的临床资料、冠状动脉造影资料,观察患者PCI成功率、并发症发生率、术后主要不良心血管事件(major adverse cardiovascular events,MACE;包括全因死亡、非致死性心肌梗死、靶血管再次血运重建)的发生率。结果应用双腔微导管对存在分叉病变的23支CTO血管进行处理,共计21支(91.3%)血管成功完成支架置入,2支血管行经皮穿刺冠状动脉腔内成形术后因靶血管过小未置入支架。所有处理的血管均实现血管开通,TIMI血流Ⅲ级,操作成功率为100%。11支(47.8%)右冠状动脉及3支(13.0%)左冠状动脉病变采用单支架策略,9支(39.1%)左冠状动脉病变采用双支架策略,其中4处采用mini-crush支架术,4处采用改良裤裙支架术,1处采用改良T支架术,所有双支架术式均完成对吻扩张。术中术后无MACE发生。结论双腔微导管可用于PCI术中协助处理存在分叉病变的CTO。

Objective To evaluate the efficacy and safety of double lumen microcatheters in chronic coronary artery total occlusion（CTO） lesions at bif urcation during percutaneous coronary intervention（PCI）. Methods From October 2013 to March 2015,we retrospectively analysed the application of double lumen microcatheter with bif urcation CTO lesions and reviewed the patients＇ clinical features, coronary angiography, intervention operation success rate, complications rates and incidence of major adverse cardiac events（including all-cause death, nonfatal myocardial infarctionand target vascular remodeling）. Results Twenty-three CTO lesions at bif urcation were treated with double lumen microcatheters, stenting were performed in 21 lesions and 2 lesions only received PTCA due to small blood vessel size. The operation success rate was 100%. All the 11 right coronary lesions and 3 lef t coronary lesions were managed using single stenting technique. Double stenting strategy was used in 9 lef t coronary lesions including 4 cases with mini-crush technique, 4 cases with modified culottes technique and one case with modified T technique. All double stenting procedures were completed by kissing balloon expansion. There was no major adverse cardiac event occured during and af ter operation. Conclusion Double lumen microcatheters are usef ul in PCI treatment of bif urcation CTO lesions.