经桡动脉6 Fr单指引导管逆向开通具有同侧侧支的左冠状动脉慢性完全闭塞病变的技术要点分析  

Analysis on the Key Points Responsible for the Successful Retrograde Recanalization of Left Coronary Artery Chronic Total Occlusions Utilizing Single 6 Fr Transradial Guiding Catheter via Ipsilateral Collateral Channels

作　　者：毛懿[1] 方填元 宫明莲 安涛[1] 乔树宾[1] 杨跃进[1] MAO Yi;FANG Tianyuan;GONG Minglian;AN Tao;QIAO Shubin;YANG Yuejin(Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases and Fuwai Hospital, CAMS and PUMC, Beijingf 100037), China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心国家心血管疾病重点实验室

出　　处：《中国循环杂志》2019年第8期757-760,共4页Chinese Circulation Journal

基　　金：中国医学科学院创新工程基金(2016-12M-1-009)

摘　　要：目的:本文旨在详细阐明经桡动脉6Fr单指引导管逆向开通具有同侧侧支的左冠状动脉慢性完全闭塞病变(CTO)的技术要点。方法:纳入由2位术者于2017年1月至2018年1月期间完成的4例经桡动脉6Fr单指引导管逆向开通具有同侧侧支的左前降支或左回旋支CTO的患者。结果:4例患者中,男性3例,女性1例,年龄均<65岁,左前降支CTO2例,左回旋支CTO2例,同侧侧支血管均是弯曲成角的心外膜侧支。手术操作全部采用桡动脉6FrEBU单指引导管,逆向导丝应用对吻导丝技术或控制性前向和逆向内膜下寻径技术(CART)通过闭塞病变,最后采取RG3导丝或者Rendezvous技术,完成体外化。患者在治疗期间均未出现并发症。结论:在选定解剖结构的病例中,通过同侧心外膜或间隔侧支通道,仅采用单根6Fr指引导管逆向开通左冠状动脉CTO是安全、可行的治疗手段。Objectives:The aim of the present study was to analyze the key points responsible for the successful retrograde recanalization of left coronary artery chronic total occlusions(CTO) utilizing single 6 Fr transradial guiding catheter via ipsilateral collateral channels.Methods:Present included 4 patients,who underwent single 6 Fr transradial guiding catheter retrograde recanalization of LAD or LCX CTO via ipsilateral collateral channels by two operators between January 2017 and January 2018 in our center.Results:A total of 4 patients(male:3,female:1;age < 65 years;LAD CTO×2,LCX CTO×2) were recruited.Ipsilateral collaterals were tortuous and angled epicardia channels.The procedures were finished via single 6 Fr EBU transradial guiding catheter.The retrograde wire crossed the occlusive lesions by Kissing wire or CART techniques.The retrograde wire externalization was achieved by exchanged RG3 or Rendezvous technique.No complications occurred.Conclusions:In selected anatomies,it is possible,feasible,and safe to achieve retrograde recanalization of left-sided CTO via ipsilateral epicardia or septal collateral channels with single 6 Fr transradial guiding catheter.

关 键 词：冠状动脉疾病 慢性完全闭塞病变 经皮冠状动脉介入 单指引导管 

分 类 号：R54[医药卫生—心血管疾病]