冠状动脉介入术中深置指引导管技术的应用与评价  

A critical appraisal of the guiding catheter deep seating technique during percutaneous coronary intervention

作　　者：高迎春[1] 马长生[1] 张崟[1] 张维东[1] 董建增[1] 聂绍平[1] 吕强[1] 贾长琪[1] 刘晓惠[1] 吴学思[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《临床心血管病杂志》2005年第8期449-451,共3页Journal of Clinical Cardiology

摘　　要：目的:分析深置指引导管技术在冠状动脉介入中的适用性和安全性。方法:在203例冠状动脉介入中采用了深置指引导管技术。涉及血管209支,包括左前降支(LAD)、左旋支(LCX)、右冠状动脉(RCA)。处理病变214处,其中C型病变占74.7%。所有病例的介入血管径路为股动脉。除4例为撤出释放了支架的球囊,余为球囊或支架难以通过病变而采用该技术。5例左主干、2例RCA开口有轻度狭窄。结果:采用深置指引导管技术进行介入的214处病变,成功处理204处,成功率95.3%。在操作成功的病例中,3例是经RCA近端已释放的支架深置指引导管,1例是经左主干支架向前降支深置指引导管,4例均成功撤出释放了支架的球囊;3例用1.5mm小球囊扩张靶病变后再深置指引导管完成后续的介入操作。1例发生左主干及LAD夹层。失败10例,其在深置指引导管下球囊或支架未能通过病变。结论:深置指引导管可有效地提高针对复杂、困难冠状动脉病变介入操作的成功率。在RCA进行该操作比较安全;但该术也可能会造成左主干及其分支内膜撕裂、夹层形成的严重并发症。Objective： To analyze the feasibility and safety of the deep seating technique of guiding catheters during percutaneous coronary intervention （PCI）. Method： The deep seating technique of guiding catheters was adopted in 203 consecutive patients undergoing PCI. The 209 coronary arteries were involved, including LAD, LCX and RCA. 214 lesions were treated, 74.70% of which was type C. Lesions PCI was performed via femoral artery access in all the patients. The technique was mainly used in case of difficulties during balloon crossing or stent deliveries, in four cases, it was used to withdraw balloons after successful stent deployment. Deep seating was also used in five left mains and two ostial RCAs with mild stenosis. Result：With the deep seating technique, 204 of the 214 deep seating procedures were successfully performed with a success rate of 95.3%. There were three cases in which guiding catheters were deeply engaged through the stents in the proximal RCA, one case in the left main. The difficulty of balloon withdrawing after successful stent deployment was overcome by using the technique in 4 cases. In another 3 cases, following the dilatation of target lesions with 1.5 mm balloon, the technique was used to facilitate stent delivery. Technical failure occurred in 10 cases. The left main and LAD dissection was found in one case showing spiral luminal filling defect, which was treated with a stent successfully. Conclusion：Deep coronary artery cannulation with guiding catheter is rather safe and feasible which can markedly increase the success rate of balloon crossing and stent delivery in complex and difficult coronary lesions.

关 键 词：冠状动脉介入术 经皮 导管插入术 深置指引导管 

分 类 号：R814.47[医药卫生—影像医学与核医学]