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(PDF)
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2007年第6期
- 页码:
- 682-683/691
- 栏目:
- 临床研究
- 出版日期:
- 2007-12-20
文章信息/Info
- Title:
- Microcatheter technique used in chronic coronary total occlusion intervention
- Author(s):
- Lv An-lin; ZHANG Jing; DIAO Fan-rong; LI Jun-jie; HU Xiao-jing; ZHANG Wei; HU Yan
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi′an 710032, Shaanxi, China
- Keywords:
- coronary total occlusion; angiography; stent
- 分类号:
- R541.4
- DOI:
- -
- 文献标识码:
- A
- 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1.5 mm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2 ml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。
- Abstract:
- 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: ClassⅠ, ClassⅡand Class Ⅲ. The distal end of the occluded blood vessel displays well in classⅠ and class Ⅱ, while no visualization in Class III. Thirtytwo 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 poststenting 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 smallsized 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.
参考文献/References
［1］ Drozd J, Opalinska E, Zapolski T, et al. Percutaneous transluminal coronary angioplasty for chronic total coronary occlusion in patients with stable angina. Relationship between lesion anatomy, procedure technique and efficacy［J］. Kardiol pol, 2005, 62(4): 332-342.
［2］ Colombo A, Mikhail GW, Michev I,et al. Treating chronic total occlusion using subintimal tracking and reentry: the STAR technique［J］. Catheter Cardiovasc Interv, 2005, 64(4): 407-411.
［3］ Hoye A, Onderwater E, Cummins P, et al. Improved recanalization of chronic total coronary occlusion using an optical coherence reflectometryguided guidewire［J］. Catheter Cardiovasc Interv, 2004, 63(2): 158-163.
备注/Memo
- 备注/Memo:
- 收稿日期：2006-07-13.作者简介：吕安林，副主任医师，博士 Email: lvanlin@fmmu.edu.cn
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