“拘禁导丝”技术的临床应用:导丝及血管的选择
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摘要
目的评价"拘禁导丝"技术处理复杂病变的效果及安全性。方法纳入2014年6月至2017年6月在中南大学湘雅二医院、岳阳市人民医院、永州市人民医院、湘西自治州人民医院行经皮冠状动脉介入治疗的患者共12 640例,其中球囊或支架不能通过病变的患者25例,21例采用了"拘禁导丝"技术,根据"拘禁导丝"的选择分为亲水涂层导丝组(9例)和无亲水涂层导丝组(12例)。评价"拘禁导丝"技术的效果及安全性,比较选择不同"拘禁导丝"手术成功率及并发症发生情况。结果21例患者中18例(18/21)手术成功,其中同一支血管作为"拘禁导丝"置入血管成功9例(9/11),不同血管成功9例(9/10),两者比较差异无统计学意义(P=0.593)。亲水涂层导丝组手术成功7例(7/9),无亲水涂层导丝组成功11例(11/12),两组间比较差异无统计学意义(P=0.386)。所有患者"拘禁导丝"均成功拔除,无相关并发症发生。结论 "拘禁导丝"技术对于球囊或支架不能通过病变是可行的。
Objective To evaluate the efficacy of the ‘ buddy-in-jail ' technique applied to complex coronary artery lesions during percutaneous coronary intervention.Methods A total of 12 640 PCI cases f rom 4 different hospitals admitted between June 2014 to June 2017 were reviewed. Among them, the balloons or stents were unable to be delivered into the lesions in 25 cases. The "buddy-in-jail" technique was applied in 21 of these 25 cases. According to the guidewires used, the 21 cases were divided into the hydrophilic coated guidewire group(n=9) and non-hydrophilic coated guidewire group(n=21). The rates of procedural success and complications were compared between the 2 groups. Results 18 cases(18/21)were successf ully treated with the "buddy-in-jail " technique. The success rates were similar between patients using the same artery(9/11) as the "buddy" vessel patients using other arteries(9/10)(P=0.593). Procedural success rates were also similar between patients using hydrophilic-coated guidewires(7/9) and non-hydrophilic coated guidewires(11/12)(P=0.386). All the wires were successfully taken out without complication.Conclusions "Buddy-in-jail" technique offers a potential alternative approach for patients with difficulty in delivering the balloon or stent to the target lesion.
Objective To evaluate the efficacy of the ‘ buddy-in-jail ' technique applied to complex coronary artery lesions during percutaneous coronary intervention.Methods A total of 12 640 PCI cases f rom 4 different hospitals admitted between June 2014 to June 2017 were reviewed. Among them, the balloons or stents were unable to be delivered into the lesions in 25 cases. The "buddy-in-jail" technique was applied in 21 of these 25 cases. According to the guidewires used, the 21 cases were divided into the hydrophilic coated guidewire group(n=9) and non-hydrophilic coated guidewire group(n=21). The rates of procedural success and complications were compared between the 2 groups. Results 18 cases(18/21)were successf ully treated with the "buddy-in-jail " technique. The success rates were similar between patients using the same artery(9/11) as the "buddy" vessel patients using other arteries(9/10)(P=0.593). Procedural success rates were also similar between patients using hydrophilic-coated guidewires(7/9) and non-hydrophilic coated guidewires(11/12)(P=0.386). All the wires were successfully taken out without complication.Conclusions "Buddy-in-jail" technique offers a potential alternative approach for patients with difficulty in delivering the balloon or stent to the target lesion.
引文
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[2]Tomey MI,Sharma SK.Interventional options for coronary artery calcification.Curr Cardiol Rep,2016,18(2):12.
[3]Morino Y,Abe M,Morimoto T,et al.Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes:the J-CTO(multicenter CTO registry in Japan)score as a difficulty grading and time assessment tool.JACC Cardiovasc Interv,2011,4(2):213-221.
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[7]Fairley SL,Spratt JC,Rana O,et al.Adjunctive Strategies in the management of resistant,undilatable coronary lesions after successfully crossing a CTO with a guidewire.Curr Cardiol Rev,2014,10(2):145–157.
[8]Bijuklic K,Schwencke C,Schofer J.Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach.Catheter Cardiovasc Interv,2016,87(5):E183-E191.
[9]赵慧强,陈晖,李虹伟,等.经挠动脉使用4 in 6子母导管技术治疗冠状动脉复杂病变的初步经验.中国介入心脏病学杂志,2016,24(12):688-691.
[10]Lee NH,Suh J,Seo HS.Double anchoring balloon technique for recanalization of coronary chronic total occlusion by retrograde approach.Catheter Cardiovasc Interv,2009,73(6):791-794.
[11]Michael TT,Banerjee S,Brilakis ES.Subintimal distal anchor technique for“balloon-uncrossable”chronic total occlusions.J Invasive Cardiol,2013,25(10):552–554.
[12]Reifart N,Enayat D,Giokoglu K.A novel penetration catheter(Tornus)as bail-out device after balloon failure to recanalise long,old calcified chronic occlusions.Euro Intervention,2008,3(5):617-621.
[13]Fang HY,Lee CH,Fang CY,et al.Application of penetration device(Tornus)f or percutaneous coronary intervention in balloon uncrossable chronic total occlusion-procedure outcomes,complications,and predictors of device success.Catheter Cardiovasc Interv,2011,78(3):356-362.
[14]Di Mario C,Ramasami N.Techniques to enhance guide catheter support.Catheter Cardiovasc Interv,2008,72(4):505-512.
[15]王均志,丁会霞,刘曙杰,等.边支双导丝技术在分叉病变中的边支保护作用.中国心血管病研究,2014,12(3):219-222.
[16]Fernandez JP,Hobson AR,Mc Kenzie D,et al.Beyond the balloon:excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions,non-crossable and non-expansible coronary lesions.Euro Intervention,2013,9(2):243-250.
[17]Pagnotta P,Briguori C,Mango R,et al.Rotational atherectomy in resistant chronic total occlusions.Catheter Cardiovasc Interv,2010,76(3):366–371.
[18]Tian W,Mahmoudi M,Lhermusier T,et al.Comparison of rotational atherectomy,plain old balloon angioplasty,and cutting-balloon angioplasty prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions.J Invasive Cardiol,2015,27(9):387–391.
[19]Bagnall AJ,Spratt JC.The “buddy-in-jail” technique—a novel method for increasing support during percutaneous coronary intervention.Catheter Cardiovasc Interv,2009,74(4):564–568.
[20]Dangoisse V,Guédès Antoine,Schro?der E.Distal‘buddy-injail’technique:a complementary‘Jail with stent’method for stent delivery.Acute Cardiac Care,2014,16(1):28–33.
[21]Balbi M,Bezante GP,Brunelli C,et al.Guide wire fracture during percutaneous transluminal coronary angioplasty:possible causes and management.Interact Cardiovasc Thorac Surg,2010,10(6):992-994.
[22]Pan M,Ojeda S,Villanueva E,et al.Structural damage of jailed guidewire during the treatment of coronary bifurcation lesions:a microscopic randomized trial.JACC Cardiovasc Interv,2016,9(18):1917-1924
[2]Tomey MI,Sharma SK.Interventional options for coronary artery calcification.Curr Cardiol Rep,2016,18(2):12.
[3]Morino Y,Abe M,Morimoto T,et al.Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes:the J-CTO(multicenter CTO registry in Japan)score as a difficulty grading and time assessment tool.JACC Cardiovasc Interv,2011,4(2):213-221.
[4]陈纪言,董豪坚,孙硕.冠状动脉慢性完全闭塞病变的不同介入途径选择及相关技术.中国介入心脏病学杂志,2014,22(12):810-813.
[5]Surmely JF,Katoh O,Tsuchikane E,et al.Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions.Catheter Cardiovasc Interv,2007,69(6):826-832.
[6]Whitlow PL,Burke MN,Lombardi WL,et al.Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques:results of the FAST-CTOs(facilitated antegrade steering technique in chronic total occlusions)trial.JACC Cardiovasc Interv,2012,5(4):393-401.
[7]Fairley SL,Spratt JC,Rana O,et al.Adjunctive Strategies in the management of resistant,undilatable coronary lesions after successfully crossing a CTO with a guidewire.Curr Cardiol Rev,2014,10(2):145–157.
[8]Bijuklic K,Schwencke C,Schofer J.Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach.Catheter Cardiovasc Interv,2016,87(5):E183-E191.
[9]赵慧强,陈晖,李虹伟,等.经挠动脉使用4 in 6子母导管技术治疗冠状动脉复杂病变的初步经验.中国介入心脏病学杂志,2016,24(12):688-691.
[10]Lee NH,Suh J,Seo HS.Double anchoring balloon technique for recanalization of coronary chronic total occlusion by retrograde approach.Catheter Cardiovasc Interv,2009,73(6):791-794.
[11]Michael TT,Banerjee S,Brilakis ES.Subintimal distal anchor technique for“balloon-uncrossable”chronic total occlusions.J Invasive Cardiol,2013,25(10):552–554.
[12]Reifart N,Enayat D,Giokoglu K.A novel penetration catheter(Tornus)as bail-out device after balloon failure to recanalise long,old calcified chronic occlusions.Euro Intervention,2008,3(5):617-621.
[13]Fang HY,Lee CH,Fang CY,et al.Application of penetration device(Tornus)f or percutaneous coronary intervention in balloon uncrossable chronic total occlusion-procedure outcomes,complications,and predictors of device success.Catheter Cardiovasc Interv,2011,78(3):356-362.
[14]Di Mario C,Ramasami N.Techniques to enhance guide catheter support.Catheter Cardiovasc Interv,2008,72(4):505-512.
[15]王均志,丁会霞,刘曙杰,等.边支双导丝技术在分叉病变中的边支保护作用.中国心血管病研究,2014,12(3):219-222.
[16]Fernandez JP,Hobson AR,Mc Kenzie D,et al.Beyond the balloon:excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions,non-crossable and non-expansible coronary lesions.Euro Intervention,2013,9(2):243-250.
[17]Pagnotta P,Briguori C,Mango R,et al.Rotational atherectomy in resistant chronic total occlusions.Catheter Cardiovasc Interv,2010,76(3):366–371.
[18]Tian W,Mahmoudi M,Lhermusier T,et al.Comparison of rotational atherectomy,plain old balloon angioplasty,and cutting-balloon angioplasty prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions.J Invasive Cardiol,2015,27(9):387–391.
[19]Bagnall AJ,Spratt JC.The “buddy-in-jail” technique—a novel method for increasing support during percutaneous coronary intervention.Catheter Cardiovasc Interv,2009,74(4):564–568.
[20]Dangoisse V,Guédès Antoine,Schro?der E.Distal‘buddy-injail’technique:a complementary‘Jail with stent’method for stent delivery.Acute Cardiac Care,2014,16(1):28–33.
[21]Balbi M,Bezante GP,Brunelli C,et al.Guide wire fracture during percutaneous transluminal coronary angioplasty:possible causes and management.Interact Cardiovasc Thorac Surg,2010,10(6):992-994.
[22]Pan M,Ojeda S,Villanueva E,et al.Structural damage of jailed guidewire during the treatment of coronary bifurcation lesions:a microscopic randomized trial.JACC Cardiovasc Interv,2016,9(18):1917-1924