慢性冠状动脉闭塞病变介入术中应用微球囊导管远段血管造影术  

Micro-catheter technique used in chronic coronary total occlusion intervention

作　　者：吕安林[1] 张晶[2] 刁繁荣[1] 李军杰[1] 胡小菁[1] 张薇[1] 胡艳[1] 

机构地区：[1]第四军医大学西京医院心脏内科,陕西西安710032 [2]西安交通大学理学院,陕西西安710049

出　　处：《心脏杂志》2007年第6期682-683,691,共3页Chinese Heart Journal

摘　　要：目的探讨冠状动脉慢性闭塞性病变再通术中钢丝是否在血管真腔内的鉴别方法,并观察其对急性心包填塞的预防作用。方法将冠状动脉闭塞性病变分为I型、II型和III型,前2型闭塞远段血管显影,后者闭塞远段血管不显影。2003年～2005年32例III型慢性闭塞病变钢丝通过病变后,采用直径为1.5mm的非快速交换小球囊通过病变(相当于微导管作用),近段造影远段血管不显影,则将钢丝退出指引导管保留球囊在原位,从钢丝孔注射2ml造影剂使远段血管显影,确认在血管真腔后预扩张、植入支架。结果32例冠状动脉III型闭塞性病变再通术患者均成功完成手术,无1例发生急性心包填塞。结论冠状动脉慢性闭塞病变微导管远段血管造影技术能鉴别钢丝是否在血管真腔内,有助于提高手术成功率,降低心包填塞发生率。AIM To explore the technique of determining whether the wire was in real space of chronic total occlusion during percutenouse coronary intervention and to observe its preventive results in acute pericardial tamponade. METHODS Coronary artery occlusion is classified into 3 types ： Class Ⅰ, Class Ⅱ and Class Ⅲ. The distal end of the occluded blood vessel displays well in class Ⅰ and class Ⅱ Class while no visualization in Class Ⅲ. Thirty-two class Ⅲ coronary artery occlusion patients were treated with percutaneous coronary intervention （PCI） between 2003 and 2005 and the results were observed. The blocked section of coronary artery was crossed with an undilated balloon catheter （diam. 1.5mm）. If the distal end of the occluded blood vessel did not display, the balloon catheter was removed. The distal end of the occluded blood vessel was displayed by the balloon catheter with contrast media. After the distal end of the occluded blood vessel was displayed, the balloon was increasingly dilated and the stent was deployed. The post-stenting angiography revealed no residual stenosis and no dissection. RESULTS Recanalization was successfully performed without acute pericardial tamponade in the 32 cases with coronary heart disease. CONCLUSION When the undilated small-sized balloon is advanced across the total occlusion of the coronary artery, angiography of distal end of the occluded blood vessel may identify whether the wire is in the real vessel, which will improve the successful rate of operation and decrease the rate of serious complication incidence.

关 键 词：冠脉闭塞病变 造影 支架 

分 类 号：R541.4[医药卫生—心血管疾病]