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Title:: Use of “motherandchild” catheter in complex percutaneous coronary intervention

作者:: 孙家安; 汝磊生; 彭育红; 赵玉英; 张莉; 王冬梅; (白求恩国际和平医院心内科，河北石家庄 050082)

Author(s):: SUN Jiaan; RU Leisheng; PENG Yuhong; ZHAO Yuying; ZHANG Li; WANG Dongmei; (Department of Cardiology, Bethune International Peace Hospital, Shijiazhuang 050082, Hebei, China)

关键词:: 冠状动脉疾病; 经皮经腔内冠状动脉成形术; 子母导管

Keywords:: coronary artery disease; angioplasty; transluminal; percutaneous; mother and child catheter

分类号:: R541.4

DOI:: -

文献标识码:: A

摘要:: 目的:复杂冠状动脉病变（慢性闭塞性病变、严重迂曲病变、弥漫钙化）的介入治疗往往需要指引导管提供较强支撑力，单纯指引导管自身能提供的支撑力常常不够。本研究旨在初步探索子母导管系统在复杂冠状动脉病变介入治疗中需要强支撑力时应用的有效性与安全性。方法：选择泰尔茂公司的Heartrail子母导管系统，系由一根5F的子指引导管和一根6F或7F的母指引导管构成。5F Heartrail子指引导管为直头指引导管，其内径为0059 in（1 in=254 mm），长度为120 cm，比母指引导管长20 cm。使用方法是，母指引导管到位后，送入经皮腔内冠状动脉成形术（PTCA）导丝至冠状动脉内，沿PTCA导丝送入子导管至母导管远段，但不伸出远端，送入PTCA球囊至冠状动脉内，沿球囊导管推送子母导管进入冠状动脉内，根据需要提供的支撑力决定子母导管伸出指引导管的长度。结果：自2008年6月~2010年12月共选择常规方法导丝、球囊或支架不能通过的复杂冠脉病变共26例（左前降支5例，左回旋支6例，右冠状动脉15例），其中慢性闭塞性病变6例（23%），血管迂曲15例（58%），近段血管有支架植入10例（38%），钙化病变15例（58%），其中24例成功完成支架植入，成功率为92%，2例失败，均为球囊不能通过病变处，术中发生空气栓塞2例（8%），经冠脉注射动脉血后血流通畅，术中无血管夹层及冠脉穿孔等并发症。随访6个月无死亡、再发心梗等心脏事件。结论：子母导管系统应用于常规方法不能成功的冠脉复杂病变可增加支撑力，有助于远端支架植入，应用有效且安全，但术中需注意空气栓塞的发生。

Abstract:: AIM:To probe the safety and efficacy of “mother and child” catheter in such complex percutaneous coronary intervention as chronic total occlusions (CTO) and serious torturous and diffuse calcified lesions. METHODS: Heartrail “mother and child” catheter (or five in six catheter) system (Terumo, Japan) involves insertion of a flexible tipped extralength 120cm 5 Fr guiding catheter through a standard 100cm 6 Fr guide catheter so that its tip extends into the vessel allowing extra deep intubation; hence, increasing backup support. In this study, the hemostatic valve was disconnected from the guide catheter and the Heartrail device was passed through the guide catheter into the target vessel either over a coronary wire or a wire and a balloon catheter with the balloon uninflated in the distal vessel. The hemostatic valve was then reattached to the end of the Heartrail catheter and the interventional procedure was performed in the usual manner through the hemostatic valve. Intubation depth was decided by the backup force needed. RESULTS: A total of 26 complex coronary lesions, which failed to cross by guide wire, balloon catheter or stent with routine methods from June, 2008 to December, 2010 were selected for the treatment with Heartrail child catheters. The lesions included five LAD (19%), six LCX (23%) and 15 RCA (58%). Among these lesions, six (23%) were CTO, 15 (58%) associated with serious torturous vessels, 10(38%) associated with proximal stent, and 15(58%) associated with serious calcification. Success was achieved in 24(92%) lesions with stent implanted and failure in two lesions which, in both, the balloon failed to cross. Air embolism was found in two lesions with normal blood flow after artery blood injection. No arterial perforation and dissection was found during the procedure. No deaths or reinfarction occurred during the 3month followup. CONCLUSION: The results indicate that “mother and child” catheter system is safe and efficient and could increase backup support and help implant distal stent when routine methods fail in complex percutaneous coronary intervention. Precautions, however, should be taken to prevent air embolism during the procedures.

参考文献/References

[1]Ikari Y,Nagaoka M,Kim JY,et al.The physics of guiding catheters for the left coronary artery in transfemoral and transradial interventions[J].J Invasive Cardiol,2005,17(12):636-641.

[2]Metz D,Meyer P,Touati C,et al.Comparison of 6F with 7F and 8F guiding catheters for elective coronary angioplasty: results of a prospective,multicenter, randomized trial[J].Am Heart J,1997,134(1):131-137.

[3]Shamoon FE,Younan SK,Chakhtoura EY.“Buddy wire” technique to overcome proximal coronary tortuosity during rotational atherectomy[J].J Invasive Cardiol,2005,17(11):E30-E32.

[4]Jafary FH.When one won’t do it,use twodouble “buddy” wiring to facilitate stent advancement across a highly calcified artery[J].Catheter Cardiovasc Interv,2006,67(5):721-723.

[5]Goldberg A,Klein R,Marmor A.Buddy wire,buddy balloon or better together![J].J Invasive Cardiol,2007,19(12):E363-E365.

[6]Mamas MA,Eichhfer J,Hendry C,et al.Use of the Heartrail II catheter as a distal stent delivery device;an extended case series[J].EuroIntervention,2009,5(2):265-271.

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应用子母导管介入治疗复杂冠状动脉病变

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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