葛雷,陆浩,戴宇翔,李晨光,秦晴,马剑英,吴轶喆,沈雳,王翔飞,王齐兵,颜彦,樊冰,黄东,姚康,张峰,钱菊英,葛均波

• 1:复旦大学附属中山医院心内科 上海市心血管病研究所

摘要(Abstract)：

目的评价135 cm扩张微导管(corsair导管,Asahi Intec Co,Japan)在冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变经桡动脉正向经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的有效性及安全性。方法回顾性入选了本中心2010年6月至2014年2月81例经桡动脉途径应用135 cm扩张微导管进行正向导引钢丝技术治疗的CTO病变患者,分析正向CTO-PCI成功率、扩张微导管通过闭塞病变成功率、球囊导管通过闭塞病变情况及导引钢丝通过闭塞病变情况,并观察住院期间不良事件发生率。结果 81例应用135 cm扩张微导管经桡动脉正向介入治疗的患者中,66例患者正向导引钢丝通过CTO病变,65例患者正向CTO-PCI成功,成功率为80.2%;另有8例成功进行逆向导引钢丝介入治疗,总体PCI成功率90.1%。66例正向导引钢丝通过闭塞病变后,135 cm扩张微导管成功通过闭塞病变56例(84.8%);扩张微导管通过闭塞病变后,球囊导管的使用数量为1.3个,显著低于扩张微导管未通过闭塞病变患者。66例正向导引钢丝通过闭塞病变的患者中,应用Fielder XT导引钢丝34例(51.5%)。住院期间随访未见扩张微导管嵌顿、折断、头端受损、血管穿孔等不良事件发生,无严重不良心脏事件发生。结论应用扩张微导管经桡动脉途径行正向CTO-PCI治疗是安全、有效的,可以简化介入治疗操作步骤,减少球囊导管等器械的使用,提高CTO病变介入治疗的手术成功率。

关键词(KeyWords)： 经皮冠状动脉介入治疗;慢性完全闭塞;冠状动脉疾病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 葛雷,陆浩,戴宇翔,李晨光,秦晴,马剑英,吴轶喆,沈雳,王翔飞,王齐兵,颜彦,樊冰,黄东,姚康,张峰,钱菊英,葛均波

参考文献(References)：

• [1]Suero JA,Marso SP,Jones PG,et al.Procedural outcomes and longterm survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries:A 20-year experience.J Am Coll Cardiol,2001,38:409-414.
• [2]Tsuchikane E,Katoh O,Kimura M,et al.The first clinical experience with a novel catheter for collateral channel tracking in retrograde approach for chronic coronary total occlusions.JACC Cardiovasc Interv,2010,3:165-171.
• [3]Rathore S,Katoh O,Tuschikane E,et al.A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking.JACC Cardiovasc Interv,2010,3:155-164.
• [4]Ma JY,Qian JY,Ge L,et al.Retrograde approach for the recanalization of coronary chronic total occlusion:Collateral selection and collateral related complication.Chin Med J(Engl),2013,126:1086-1091.
• [5]Joseph G,Thomson VS,Radhakrishnan S.Corsair microcatheter for retrograde coronary chronic total occlusion recanalization:Early experience outside the realm of dedicated recanalization specialists.Indian Heart J,2012,64:388-393.
• [6]葛均波,葛雷,马剑英,等.扩张微导管在冠状动脉慢性完全闭塞病变中的应用.中国介入心脏病学杂志,2010,18:1-4.
• [7]Ge L,Qian JY,Liu XB,et al.Retrograde approach for the recanalization of coronary chronic total occlusion:Preliminary experience of a single center.Chin Med J(Engl),2010,123:857-863.
• [8]Sianos G,Werner GS,Galassi AR,et al.Recanalisation of chronic total coronary occlusions:2012 consensus document from the eurocto club.EuroIntervention,2012,8:139-145.
• [9]Di Mario C,Werner GS,Sianos G,et al.European perspective in the recanalisation of chronic total occlusions(cto):Consensus document from the eurocto club.EuroIntervention,2007,3:30-43.
• [10]Morino Y,Kimura T,Hayashi Y,et al.In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the j-cto registry(multicenter cto registry in japan).JACC Cardiovasc Interv,2010,3:143-151.
• [11]葛均波,葛雷.冠状动脉慢性完全闭塞病变介入治疗.北京:人民卫生出版社,2009.
• [12]葛均波,傅国胜,葛雷.冠状动脉慢性完全闭塞病变介入治疗2013-进展与病例分享.北京:人民卫生出版社,2013.
• [13]葛均波,黄东,张峰,等.螺旋穿透导微管(Tornus)在冠状动脉慢性完全闭塞病变介入治疗中的应用.中国介入心脏病学杂志,2008,16:184-186.