逆向开通慢性完全闭塞病变介入治疗过程中侧支通道穿孔的治疗及预后

Management and outcome of collateral channel perforation during percutaneous coronary intervention for chronic total occlusion with retrograde approach

目的:通过回顾性分析12例沧州市中心医院尝试逆向开通完全闭塞病变介入治疗过程中发生侧支通道穿孔患者的临床及影像资料,分析侧支通道穿孔的治疗及预后。方法:2009-01-2017-01我院共有238例慢性完全闭塞病变患者尝试通过逆向途径开通,其中12例患者并发逆向侧支通道穿孔。回顾分析12例患者的临床及冠状动脉影像资料,对穿孔的特点、治疗方法、治疗结果及近期预后进行总结。结果:12例患者中7例为间隔支侧支通道穿孔,5例为心外膜侧支通道穿孔,7例间隔支侧支通道穿孔患者中6例为指引导丝介导的穿孔,均未进行特殊处理,1例为微导管注射造影剂所致,应用微导管注射凝血酶栓塞侧支通道治疗成功。5例心外膜侧支通道穿孔患者,最终均进行了正、逆向双侧栓塞治疗,其中1例术中只应用弹簧圈进行单侧栓塞治疗,术后并发延迟心包压塞。经心包穿刺引流、弹簧圈栓塞对侧后病情好转。1例应用弹簧圈双侧栓塞治疗,术后并发延迟心包压塞,经心包穿刺引流,双侧凝血酶栓塞治疗后好转。其余3例均应用凝血酶双侧栓塞治疗成功。结论:对于导引导丝介导的室间隔侧支穿孔可密切监测。对于成功开通慢性完全闭塞病变发生心外膜侧支穿孔的患者应进行双侧栓塞治疗。凝血酶较弹簧圈可能是一种更理想的治疗心外膜侧支穿孔的血栓形成物质。

Objective:To retrospectively analyze the clinical and coronary imaging data of 12 cases with collateral channel perforation during percutaneous coronary intervention for chronic total occlusion with retrograde approach in Cangzhou Centre Hospital.Method:A total of 238 cases with retrograde approach after percutaneous coronary intervention in chronic total occlusion from January 2009 to January 2017,were screened retrospectively and 12 cases of them were complicated collateral channel perforation.The clinic and coronary imaging data of 12 patients were analyzed retrospectively.We summarized the features,treatment,outcome and short term prognosis of collateral channel perforation.Result:The 7 patients were septal collateral channel perforation and 5 patients were epcardial collateral channel perforation.In patients of septal collateral channel perforation,6 patients were guidewire-induced septal collateral channel perforation.We didn’t do special management.One patient was caused by microcatheter injecting constrast material.The patient was successful treated by septal collateral channel perforation with microcatheter delivery of intracoronary thrombin.Five patients with epcardial collateral channel perforation were ultimately successful treatment by embolize bilaterally.One of the five patients didn’t initially treat bilaterally,he had delayed cardiac tamponade.He were successful treatment by coil embolize contralateral and pericardiocentesis.One of the five patients was treated by coil embolize bilaterally.He had also delayed cardiac tamponade.He were successful treatment by thrombin embolize contralateral and pericardiocentesis.The other patients were successfully treated by thrombin embolize bilaterally.Conclusion:We only need monitoring carefully to guidewire-induced septal collateral channel perforation.We need embolize bilaterally to epcardial collateral channel perforation with successful treatment of chronic total occlusion.Thrombin may be an ideal thrombus forming substance for the treatment of epicardial collateral perforation compared with coil.