林敬业,钟志安,张斌,黄泽涵,吴开泽,廖洪涛

• 1:广东省心血管病研究所心内科广东省人民医院广东省医学科学院

摘要(Abstract)：

目的探讨一种新的改良反向控制性正向和逆向内膜下寻径(CART)技术开通慢性完全闭塞(CTO)病变的有效性及安全性。方法对13例冠状动脉CTO病变患者行改良反向CART技术。该技术在传统反向CART技术基础上,使用Knuckle技术帮助正向导丝进入内膜下间隙,配合运用操控性好、穿透能力强的逆向导丝及正向球囊在CTO病变处进行扩张,使逆向导丝通过病变进入病变近段血管真腔。所有患者术中对病变进行常规J-CTO评分,对侧支进行Werner分级。结果 13例患者中10例CTO病变位于右冠状动脉,3例位于前降支。J-CTO评分1分2例(2/13),2分4例(4/13),3分6例(6/13)及4分1例(1/13)。侧支Werner分级1级9例(9/13),2级4例(4/13)。13例患者均取得技术成功,1例因侧支循环穿孔行心包穿刺。结论运用本项改良的反向CART技术可高效安全地开通CTO病变。

关键词(KeyWords)： 慢性完全闭塞病变;经皮冠状动脉介入治疗;反向控制性正向和逆向内膜下寻径技术

Abstract:

Keywords:

基金项目(Foundation): 广东省省级科技计划项目(2016A020216022)

作者(Author): 林敬业,钟志安,张斌,黄泽涵,吴开泽,廖洪涛

参考文献(References)：

• [1]Galassi,AR,Brilakis ES,Boukhris M,et al.Appropriateness of percutaneous revascularization of coronary chronic total occlusions:an overview.Eur Heart J,2016,37(35):2692-2700.
• [2]Tamburino C,Capranzano P.Retrograde approach for chronic total occlusion percutaneous coronary intervention.Cir Cardiovasc Interv,2016,9(6):e004023.
• [3]Brilakis ES,Grantham JA,Rinfret S,et al.A percutaneous treatment algorithm f or crossing coronary chronic total occlusions.JACC Cardiovasc Interv,2012,5(4):367-379.
• [4]Yoshimachi F,Torii S,Naito T.A novel percutaneous coronary intervention technique for chronic total occlusion:Contralateral angiography with a single guiding catheter.Catheter Cardiovasc Interv,2016,87(6):E229-E232.
• [5]Harding SA,Wu EB,Lo S,et al.A new algorithm for crossing chronic total occlusions from the Asia Pacifi c Chronic Total Occlusion Club.JACC Cardiovasc Interv,2017,10(21):2135-2143.
• [6]Huang Z,Zhang B,Chai W,et al.Usefulness and safety of a novel modifi cation of the retrograde approach for the long tortuous chronic total occlusion of coronary arteries.Int Heart J,2017,58(3):351-356.
• [7]Galassi AR,Sianos G,Werner GS,et al.Retrograde recanalization of chronic total occlusions in Europe:procedural,in-hospital,and long-term outcomes from the multicenter ERCTO registry.J Am Coll Cardiol,2015,65(22):2388-2400.