冠状动脉CT影像转入磁导航系统指导介入治疗的临床研究

摘要

目的 探讨CT路标和磁导航系统指导下经皮冠状动脉介入治疗(PCI)的可行性、有效性和安全性.方法2011年6月至2012年5月连续入选门诊双源CT检查诊断冠心病,并经冠状动脉造影确诊、拟行PCI的冠心病患者30例.将靶血管的冠状动脉CT影像转入磁导航系统,经剪辑、重建后投照在X线屏幕上作为实时路标.记录靶病变特征、放置导丝过程所需的时间、X线暴露量、对比剂用量及相关并发症.结果 对30例入选患者的36处靶病变进行了介入治疗.其中A型病变16处、B1型病变11处、B2型病变8处、C型病变1处.靶病变长度为(22.0 ±9.8)mm、狭窄程度为(81.3±10.3)％.在CT路标和磁导航系统指导下,磁导丝通过病变36处,通过率为100％.导丝放置时间为92.5(56.6～131.3)s；X线暴露量为235.0(123.5～ 395.1) μGym2/36.5 (21.3～ 67.8) mGy；对比剂用量为0.0(0.0～3.0)ml,其中21(58.3％)处靶病变在放置导丝过程中未使用对比剂.所有靶血管均成功接受介入治疗,未发生与磁导航系统相关的并发症.结论 CT路标和磁导航引导下行PCI是可行、有效和安全的,这一方法可能对指导闭塞病变介入治疗时的导丝放置有重要价值.%Objective To evaluate the feasibility,efficacy and safety of the percutaneous coronary intervention(PCI) guided by computed tomography(CT) coronary angiography derived roadmap and magnetic navigation system(MNS).Methods During June 2011 and May 2012,thirty consecutive patients receiving elective PCI were enrolled,coronary artery disease was primarily diagnosed by dual-source CT coronary angiography(DSCT-CA) at outpatient clinic and successively proved by coronary artery angiography in the hospital.Target vessels from pre-procedure DSCT-CA were transferred to the magnetic navigation system,and consequently edited,reconstructed,and projected onto the live fluoroscopic screen as roadmaps.Parameters including characters of the target lesions,time,contrast volume,radiation dosage for guidewire crossing,and complications of the procedure were recorded.Results Thirty patients with 36 lesions were recruited and intervened by PCI.Among the target lesions,sixteen were classified as type A,11 as type B1,8 as type B2,1 as type C.The average length of the target lesions was (22.0 ± 9.8) mm,and the average stenosis of the target lesions was(81.3 ± 10.3)％.Under the guidance of CT roadmap and MNS,36 target lesions were crossed by the magnetic guidewires,with a lesion crossing ratio of 100％.The time of placement of the magnetic guidewires was 92.5 (56.6-131.3)seconds.The contrast volume and the radiation dosage for guidewire placement were 0.0 (0.0-3.0) ml and 235.0 (123.5-395.1) μGym2/36.5 (21.3-67.8)mGy,respectively.Guidewires were successfully placed in 21 (58.3％) lesions without contrast agent.All enrolled vessels were successfully treated,and there were no MNS associated complications.Conclusions It is feasible,effective and safe to initiate PCI under the guidance of CT derived roadmap and MNS.This method might be helpful for the guidewire placement in the treatment of total occlusions.