CAJ | 학술논문

目的探讨CT路标和磁导航系统指导下经皮冠状动脉介入治疗(PCI)的可行性、有效性和安全性.方法2011年6月至2012年5月连续入选门诊双源CT检查诊断冠心病,并经冠状动脉造影确诊、拟行PCI的冠心病患者30例.将靶血管的冠状动脉CT影像转入磁导航系统,经剪辑、重建后投照在X线屏幕上作为实时路标.记录靶病变特征、放置导丝过程所需的时间、X线暴露量、对比剂用量及相关并发症.结果对30例入选患者的36处靶病变进行了介入治疗.其中A型病变16处、B1型病变11处、B2型病变8处、C型病变1处.靶病变长度为(22.0 ±9.8)mm、狭窄程度为(81.3±10.3)％.在CT路标和磁导航系统指导下,磁导丝通过病变36处,通过率为100％.导丝放置时间为92.5(56.6～131.3)s；X线暴露量为235.0(123.5～ 395.1) μGym2/36.5 (21.3～ 67.8) mGy；对比剂用量为0.0(0.0～3.0)ml,其中21(58.3％)处靶病变在放置导丝过程中未使用对比剂.所有靶血管均成功接受介入治疗,未发生与磁导航系统相关的并发症.结论 CT路标和磁导航引导下行PCI是可行、有效和安全的,这一方法可能对指导闭塞病变介入治疗时的导丝放置有重要价值.
목적 탐토CT로표화자도항계통지도하경피관상동맥개입치료(PCI)적가행성、유효성화안전성.방법2011년6월지2012년5월련속입선문진쌍원CT검사진단관심병,병경관상동맥조영학진、의행PCI적관심병환자30례.장파혈관적관상동맥CT영상전입자도항계통,경전집、중건후투조재X선병막상작위실시로표.기록파병변특정、방치도사과정소수적시간、X선폭로량、대비제용량급상관병발증.결과 대30례입선환자적36처파병변진행료개입치료.기중A형병변16처、B1형병변11처、B2형병변8처、C형병변1처.파병변장도위(22.0 ±9.8)mm、협착정도위(81.3±10.3)％.재CT로표화자도항계통지도하,자도사통과병변36처,통과솔위100％.도사방치시간위92.5(56.6～131.3)s；X선폭로량위235.0(123.5～ 395.1) μGym2/36.5 (21.3～ 67.8) mGy；대비제용량위0.0(0.0～3.0)ml,기중21(58.3％)처파병변재방치도사과정중미사용대비제.소유파혈관균성공접수개입치료,미발생여자도항계통상관적병발증.결론 CT로표화자도항인도하행PCI시가행、유효화안전적,저일방법가능대지도폐새병변개입치료시적도사방치유중요개치.
Objective To evaluate the feasibility,efficacy and safety of the percutaneous coronary intervention(PCI) guided by computed tomography(CT) coronary angiography derived roadmap and magnetic navigation system(MNS).Methods During June 2011 and May 2012,thirty consecutive patients receiving elective PCI were enrolled,coronary artery disease was primarily diagnosed by dual-source CT coronary angiography(DSCT-CA) at outpatient clinic and successively proved by coronary artery angiography in the hospital.Target vessels from pre-procedure DSCT-CA were transferred to the magnetic navigation system,and consequently edited,reconstructed,and projected onto the live fluoroscopic screen as roadmaps.Parameters including characters of the target lesions,time,contrast volume,radiation dosage for guidewire crossing,and complications of the procedure were recorded.Results Thirty patients with 36 lesions were recruited and intervened by PCI.Among the target lesions,sixteen were classified as type A,11 as type B1,8 as type B2,1 as type C.The average length of the target lesions was (22.0 ± 9.8) mm,and the average stenosis of the target lesions was(81.3 ± 10.3)％.Under the guidance of CT roadmap and MNS,36 target lesions were crossed by the magnetic guidewires,with a lesion crossing ratio of 100％.The time of placement of the magnetic guidewires was 92.5 (56.6-131.3)seconds.The contrast volume and the radiation dosage for guidewire placement were 0.0 (0.0-3.0) ml and 235.0 (123.5-395.1) μGym2/36.5 (21.3-67.8)mGy,respectively.Guidewires were successfully placed in 21 (58.3％) lesions without contrast agent.All enrolled vessels were successfully treated,and there were no MNS associated complications.Conclusions It is feasible,effective and safe to initiate PCI under the guidance of CT derived roadmap and MNS.This method might be helpful for the guidewire placement in the treatment of total occlusions.