CAJ | 학술논문

目的评估逆向介入治疗冠状动脉慢性完全闭塞合并钙化病变的有效性和安全性.方法 4例冠状动脉慢性完全闭塞合并钙化病变,3例右冠,1例前降支病变；4例闭塞处均有分支,2例明显迂曲,1例为前降支开口病变；在150 cm Finecross微导管的支持下,4例全部采用逆向导丝技术,其中3例直接选用逆向介入治疗,1例正向失败后选用逆向方法.结果 4例逆向导丝均通过侧支循环送到闭塞病变远端,1例通过左回旋支至右冠的心外膜下侧支,3例通过间隔支；2例采用反向CART技术,随后逆向导丝体外化；1例使用正逆向微导管对吻钢丝技术,即正逆向微导管在正向指引导管对吻后,正向导丝经逆向微导管通过左前降支闭塞病变；1例逆向及正向导丝均未能通过严重钙化和迂曲的右冠闭塞病变,未能开通闭塞血管.手术成功率75％,3例开通血管均植入药物洗脱支架.4例术中及住院期间未发生并发症.结论逆向介入治疗冠状动脉慢性完全闭塞合并钙化病变是有效和安全的.
목적 평고역향개입치료관상동맥만성완전폐새합병개화병변적유효성화안전성.방법 4례관상동맥만성완전폐새합병개화병변,3례우관,1례전강지병변；4례폐새처균유분지,2례명현우곡,1례위전강지개구병변；재150 cm Finecross미도관적지지하,4례전부채용역향도사기술,기중3례직접선용역향개입치료,1례정향실패후선용역향방법.결과 4례역향도사균통과측지순배송도폐새병변원단,1례통과좌회선지지우관적심외막하측지,3례통과간격지；2례채용반향CART기술,수후역향도사체외화；1례사용정역향미도관대문강사기술,즉정역향미도관재정향지인도관대문후,정향도사경역향미도관통과좌전강지폐새병변；1례역향급정향도사균미능통과엄중개화화우곡적우관폐새병변,미능개통폐새혈관.수술성공솔75％,3례개통혈관균식입약물세탈지가.4례술중급주원기간미발생병발증.결론 역향개입치료관상동맥만성완전폐새합병개화병변시유효화안전적.
Objective To evaluate the efficacy and safety of retrograde wire in chronic total occlusion with calcification.Methods 4 patients with chronic total occlusion with calcification were selected.3 RCA and 1 LAD as CTO target vessel.Side branches proximal to the occlusion waspresent in all patients,2 of 4 with extreme tortuosity,1 of 4 with ostial occlusion in LAD.At the support of 150cm Finecross microcatheter,all patients were treated with the retrograde technique,with 3 of 4 as primary strategy,1 of 4 as immediately after antegrade failure.Results Retrograde wire crossed the collaterals and successfully delivered distal to the occlusion in all patients.Epicardial collateral from LCX to RCA was accessed in 1 patient,and septal in 3 of 4 patients.Reverse CART technique was applied in 2 of 4 patients,and subsequent exteriorization of the retrograde wire via the antegrade guide was completed.Kissing of antegrade and retrograde microcatheters inside antegrade guide was completed and antegrade wire crossed the CTO lesion via retrograde microcatheter in 1 patient.Both retrograde and antegrade wires could not cross the CTO lesion in 1 patient with extreme tortuosity and severe calcification,and the RCA CTO lesion was not opened in this patient.Overall successful rate was 75％.Drug eluting stents were implanted in 3 successfully recanalized vessels.All patients had no complications during procedure and subsequent hospitalization.Conclusion The retrograde approach was used with high degree of success and safety in chronic total occlusion with calcification.