CAJ | 학술논문

背景和目的:冠状动脉口部病变的经皮冠状动脉介入(PCI)治疗手术操作难度大,易有并发症,既要支架准确植入口部病变,又要边支不受压.本研究探讨解决这一难题的Szabo技术的成功率、安全性和可行性.方法:Szabo技术是利用边支导丝(抛锚导丝)穿过支架最靠近边支的支架网眼,防止支架前进时停止在口部病变外,保证主支导丝穿过支架腔.作者回顾性分析利用Szabo 技术治疗39例病人冠状动脉口部病变的结果.手术操作成功定义:支架没有脱落,边支导丝没有退出.造影成功定义:支架准确植入到口部,而边支没有受压.血管内超声定义成功:支架准确植入到口部,近段没有突出,支架完全覆盖病变.39例病人中,男性28 例,女性11例,年龄43～79,平均(65±12)岁.6F 和7F 指引导管分别用于35例 (89.7%) 和 4 (10.3%) 例病人.经桡动脉途径31 (79.5%) 例和经股动脉途径8 (20.5%)例.病变相关血管:前降支 (LAD) 26 (66.7%)例,右冠(RCA) 5 (12.8%)例,旋支及钝缘支 (LCX-OM) 3 (7.7%)例,后降支(PDA) 5 (12.8%)例.支架植入后30 (76.9%) 例病变相关血管和9 (23.1%) 例边支血管经过了血管内超声(IVUS)检查.结果:手术操作成功:36 例 (92.3%),这36 例造影均成功(100%).IVUS 检测:支架准确植入口部者96.7% (29例/30例),支架近段轻度凸出的只有1 例(3.3%).没有发生严重并发症.结论:结果说明 Szabo技术用于冠状动脉口部病变PCI成功率很高,是安全和可行的,值得推广.
배경화목적:관상동맥구부병변적경피관상동맥개입(PCI)치료수술조작난도대,역유병발증,기요지가준학식입구부병변,우요변지불수압.본연구탐토해결저일난제적Szabo기술적성공솔、안전성화가행성.방법:Szabo기술시이용변지도사(포묘도사)천과지가최고근변지적지가망안,방지지가전진시정지재구부병변외,보증주지도사천과지가강.작자회고성분석이용Szabo 기술치료39례병인관상동맥구부병변적결과.수술조작성공정의:지가몰유탈락,변지도사몰유퇴출.조영성공정의:지가준학식입도구부,이변지몰유수압.혈관내초성정의성공:지가준학식입도구부,근단몰유돌출,지가완전복개병변.39례병인중,남성28 례,녀성11례,년령43～79,평균(65±12)세.6F 화7F 지인도관분별용우35례 (89.7%) 화 4 (10.3%) 례병인.경뇨동맥도경31 (79.5%) 례화경고동맥도경8 (20.5%)례.병변상관혈관:전강지 (LAD) 26 (66.7%)례,우관(RCA) 5 (12.8%)례,선지급둔연지 (LCX-OM) 3 (7.7%)례,후강지(PDA) 5 (12.8%)례.지가식입후30 (76.9%) 례병변상관혈관화9 (23.1%) 례변지혈관경과료혈관내초성(IVUS)검사.결과:수술조작성공:36 례 (92.3%),저36 례조영균성공(100%).IVUS 검측:지가준학식입구부자96.7% (29례/30례),지가근단경도철출적지유1 례(3.3%).몰유발생엄중병발증.결론:결과설명 Szabo기술용우관상동맥구부병변PCI성공솔흔고,시안전화가행적,치득추엄.
Objective:Background Percutaneous coronary intervention (PCI) on ostial lesions in coronary arteries associated with higher procedural difficulty and complication morbility. It has been technically difficult because it should be done with precise stent placement in ostium and absence of side branch compromise. The Szabo technique consists of side branch wiring through most proximal stent strut as well as main branch wiring through stent lumen. The side branch wire or anchor wire prevents stent advancement beyond ostial segment and makes possible the accurate stent implantation in ostium. The purpose of this study is to evaluate the safety, feasibility and success rate of Szabo technique by analysing technical, angiographic and IVUS (Intravascular Ultrasonography) findings.Methods:The data of 39 PCIs in 39 patients with a significant lesion at a coronary artery ostium which was treated percutaneously using Szabo technique were retrospectively analysed. The technically successful procedure was defined as there was neither stent loss nor second guide wire pull back during stent advancement. A successful procedure from angiographic point of view was defined as a precise stent implantation at ostium without side branch compromise. Successful procedure from IVUS point of view was defined as accurate stent placement in ostium without proximal protrusion and without any stent uncovered area. A total of 39 patients was with 28 males and 11 females. They aged from 43 to 79 years with a mean age of (65±12)years. The 6F and 7F guiding catheter were used in 35 (89.7%) and 4 (10.3%) patients separately. The access was radial in 31 (79.5%) and femoral in 8 (20.5%) patients. The culprit vessel was left anterior descending (LAD) in 26(66.7%), right coronary artery (RCA) 5 (12.8%), circumflex-obtuse marginal (LCX-OM) 3(7.7%), and posterior descending (PDA) 5(12.8%). IVUS was performed through culprit vessel in 30 (76.9%) and was also done in side branch in 9 (23.1%) patients after stent implantation.Results:The procedure was technically successful in 36 (92.3%) patients. All technically successful patients had angiographic success (100%). IVUS examination of culprit vessel showed accurate stent placement in ostium 29 (96.7%) and slight stent proximal protrusion in 1(3.3%) patients. No serious complication occured. Conclusion:This study shows that Szabo technique is safe and feasible for PCI in ostial coronary artery lesions with a high angiographic success rate,its deserved to spread.