新型国产冠状动脉内微抓捕器在冠状动脉慢性完全闭塞病变逆向介入技术中应用的早期经验Early experience of the application of a novel domestic micro-snare in the externalization of retrograde wire in chronic total occlusion percutaneous coronary intervention
王慧勇,罗建方
摘要(Abstract):
目的本研究初步探讨冠状动脉慢性完全闭塞(CTO)病变使用逆向介入技术时,利用新型国产微抓捕器在冠状动脉内抓捕逆向导丝的安全性及有效性。方法自2018年6月至2019年7月,连续入选广东省心血管病研究所CTO病变使用逆向介入技术时,逆向导丝体外化过程中应用新型国产微抓捕器12例患者。12例患者平均年龄66.8岁,平均CTO病变介入策略预测评分2.3分。12例患者中CTO病变位于右冠状动脉6例、左前降支6例。12例患者均是逆向导丝通过CTO后,由于各种原因逆向导丝反复不能进入正向指引导管内而使用新型国产冠状动脉内抓捕器辅助完成手术。结果利用新型国产微抓捕器在冠状动脉内抓捕逆向导丝平均耗时4.2 min,使用对比剂0 ml,术中术后无冠状动脉血管栓塞、穿孔、破裂、导丝不能松解等与使用新型国产抓捕器相关的并发症发生。结论使用新型国产微抓捕器在冠状动脉内抓捕逆向导丝是安全和高效的,但需要术者有丰富的CTO经皮冠状动脉介入治疗经验和轻松驾驭相关器械的能力。
关键词(KeyWords): 慢性完全闭塞;逆向经皮冠状动脉介入治疗;微抓捕器
基金项目(Foundation): 广州市产学研协同创新重大专项(1561000356)
作者(Author): 王慧勇,罗建方
参考文献(References):
- [1]沈卫峰,沈迎,丁风华,等.冠状动脉慢性完全闭塞病变病理生理机制和血运重建策略.中国介入心脏病学杂志,2019,27(1):3-5.
- [2]中国冠状动脉慢性闭塞病变介入治疗俱乐部.中国冠状动脉慢性完全闭塞病变介入治疗推荐路径.中国介入心脏病学杂志,2018,26(3):121-128.
- [3]张奇.冠状动脉慢性完全闭塞病变经皮冠状动脉介入治疗并发症防治策略.中国介入心脏病学杂志,2017,25(12):703-705.
- [4] 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.
- [5] Godino C, Sharp A, Carlino M, et al. Crossing CTOs–the tips,tricks and specialist kit that can mean the difference between success and failure. Catheter Cardiovasc Interv, 2009,74(7):1019-1046.
- [6] Tamburino C,Capranzano P. Retrograde approach for chronic total occlusion percutaneous coronary intervention. Cir Cardiovasc Interv,2016,9(6):e004023.
- [7] Fang HY, Lee WC, Fang CY, et al. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention-a step by step practical approach and an observational study.Medicine(Baltimore),2016,95(41):e5129.
- [8] Shorrock D, Michael T, Patel V, et al. Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions:a case series and systemic review of the literature. Catheter Cardiovasc Interv,2014,84(4):670-675.
- [9] Yokoi K, Sumitsuji S, Kaneda H, et al. A novel homemade snare,safe, economical and size-adjustable. EuroIntervention,2015,10(11):1307-1310.