边支血管内超声指导开通主支无残端慢性完全闭塞病变

摘要

Objective To investigate the possibility and efficacy of opening the stumpless chronic total occlusion ( CTO) of coronary artery with guidance by intravascular ultrasound ( IVUS) in the side branch. Methods Fourteen patients with coronary artery disease were enrolled from April, 2010 to September, 2016. The stumpless CTOs in main coronary artery with a side branch at the location of CTO were found in these patients under coronary angiography. The IVUS catheter was sent to the side branch by the wire in it. The wire in the main coronary artery was manipulated into the proximal edge in true lumen of CTO. Results Percentage of attempting to find the proximal edge of CTO in middle segment of left anterior descending artery by IVUS in diagonal branch is the highest of 71. 4%. Twelve CTOs archieved a successful penetration in proximal edge by the guidance of IVUS in the branch artery. Nine CTOs were crossed by the wire in true lumen. Twelve CTOs were tried with Fielder XT firstly, one of which was eventually success. Eleven CTOs were penetrated by the stiffer CTO wire. Conclusions It is feasible that the stumpless CTO to be opened with the guidance by IVUS in the side branch. The first choice for wire should be the stiffer CTO wire, not the taped soft wire in this situation.%目的：研究边支血管内超声(intravascular ultrasound,IVUS)指导开通冠状动脉主支无残端慢性完全闭塞病变(chronic total occlusion,CTO)的可能性和疗效。方法自2010年4月至2016年9月,沈阳军区总医院心内科对14例冠状动脉主支有 CTO,闭塞处无残端但有分支的冠心病患者行边支内 IVUS,在 IVUS 指导下对主支 CTO 实施经皮冠状动脉介入治疗( percutaneous coronary intervention,PCI)。结果经对角支内 IVUS 寻找前降支中段 CTO 闭塞段开口10例,比例最高,占71.4％。 IVUS 指导导丝穿刺 CTO 残端成功12例,占85.7％。穿刺 CTO 残端后成功通过 CTO 达到远端真腔9例,占64.3％。共对12例患者首先尝试应用 Fielder XT 导丝,1例成功穿刺 CTO 残端。应用高硬度 CTO 专用导丝成功穿刺 CTO 残端11例。结论边支内 IVUS 指导开通冠状动脉主支无残端 CTO 是可行的,此种情况下应首选硬度较强的 CTO 专用导丝而非硬度较差的锥形导丝。