CAJ | 학술논문

目的：探讨逆向导丝技术治疗前向失败的冠状动脉慢性完全闭塞（chronic total occlusion， CTO）病变的可行性和安全性。方法选择2008年6月至2011年12月在本院住院治疗的22例冠心病患者，年龄51～68（59±7）岁，男15例，女7例。冠状动脉造影显示冠状动脉CTO，其中14例右冠状动脉CTO，8例左冠状动脉前降支CTO。常规行前向导丝技术失败后，采用逆向导丝技术行冠状动脉介入治疗，观察手术成功率、手术时间、X线曝光时间、造影剂用量、并发症和主要不良心脏事件（包括心源性死亡、心肌梗死、靶病变血运重建）。结果20例患者行逆向导丝技术成功，成功率为90.9%，手术时间为112～226（162±35）分钟、X线曝光时间为54～98（72±20）分钟、造影剂用量为180～290（236±27）ml、无心源性死亡和其他严重并发症发生。患者随访3～36个月，2例患者再发心绞痛，复查冠状动脉造影示：1例出现支架内再狭窄，另1例为非靶血管狭窄。结论当前向导丝技术不能通过CTO时，应用逆行导丝技术是可行和安全的，可明显提高手术成功率。
목적：탐토역향도사기술치료전향실패적관상동맥만성완전폐새（chronic total occlusion， CTO）병변적가행성화안전성。방법선택2008년6월지2011년12월재본원주원치료적22례관심병환자，년령51～68（59±7）세，남15례，녀7례。관상동맥조영현시관상동맥CTO，기중14례우관상동맥CTO，8례좌관상동맥전강지CTO。상규행전향도사기술실패후，채용역향도사기술행관상동맥개입치료，관찰수술성공솔、수술시간、X선폭광시간、조영제용량、병발증화주요불양심장사건（포괄심원성사망、심기경사、파병변혈운중건）。결과20례환자행역향도사기술성공，성공솔위90.9%，수술시간위112～226（162±35）분종、X선폭광시간위54～98（72±20）분종、조영제용량위180～290（236±27）ml、무심원성사망화기타엄중병발증발생。환자수방3～36개월，2례환자재발심교통，복사관상동맥조영시：1례출현지가내재협착，령1례위비파혈관협착。결론당전향도사기술불능통과CTO시，응용역행도사기술시가행화안전적，가명현제고수술성공솔。
Objective To investigate the feasibility and safety of retrograde guidewire therapy in anterograde failed chronic coronary total occlusion (CTO). Methods A total of 22 cases of coronary heart disease with CTO were treated from June 2008 to December 2011 in our hospital, aged 51 ~ 68 (59±7) years of age, 15 males and 7 females. Coronary angiography showed coronary artery CTO, of which 14 were right coronary artery CTO, 8 patients with left anterior descending coronary artery CTO. After a failed antegrade CTO recanalization attempt, a retrograde approach via septal collaterals was tried. Success rate, procedure time, X-ray exposure time, contrast agent, complications and major adverse cardiac events were recorded (including cardiac death, myocardial infarction and target lesion revascularization). Results 20 patients underwent successful retrograde guidewire technique, with a the success rate of 90.9%, procedure time 112~226 (162±35) min, X-ray exposure time of 54 ~ 98 (72±20) min, contrast agent 180 ~ 290 (236±27) ml, without cardiac death and other serious complications. Patients were followed up for 3~36 months. Two patients had recurrent angina. Coronary angiography showed one case of restenosis, and the other non-target vessel stenosis. Conclusions When the antegrade guidewire technique could not be passed along CTO, the retrograde guidewire therapy was feasible and safe, could increase the technical success rate of CTO recanalization attempts.