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目的探讨穿微导管技术在逆向经皮冠状动脉介入治疗(PCI)中的应用,并评价其有效性及安全性。方法入选2014年1月至2014年12月广东省人民医院心内科二病区行逆向PCI治疗的冠状动脉慢性完全闭塞(CTO)病变患者81例。采用穿微导管技术建立PCI轨道,收集患者的临床资料、影像学资料和PCI手术情况,观察患者术中及住院期间不良事件的发生情况。结果81例行逆向PCI的CTO病变患者中,71例成功通过侧支循环,69例逆向PCI成功(85.2%),术中发生心脏压塞2例,腹膜后血肿2例。69例逆向PCI成功患者中,逆向导丝成功通过CTO病变后,穿微导管技术建立PCI轨道失败1例,穿微导管技术成功率为98.6%。12例逆向PCI失败的原因分别为:逆向导丝无法通过侧支循环10例,无法通过CTO病变2例。结论穿微导管技术是体内导丝穿入微导管的方法,安全、有效,可作为逆向PCI中建立PCI轨道的常规方法之一。
Objective To investigate the application of microcatheter in the treatment of percutaneous coronary intervention (PCI) and to evaluate its effectiveness and safety. Methods Eighty-one patients with chronic coronary artery occlusion (CTO) underwent reverse PCI during January 2014 to December 2014 in Department of Cardiology, Guangdong Provincial People’s Hospital. The micro-catheter technique was used to establish PCI orbit. The clinical data, imaging information and PCI operation were collected. The occurrence of adverse events during operation and hospitalization were observed. Results Of the 81 patients with CTO lesions undergoing reverse PCI, 71 successfully passed the collateral circulation and 69 patients achieved reverse PCI (85.2%). There were 2 patients with cardiac tamponade and 2 patients with retroperitoneal hematoma. Among the 69 patients with successful PCI, the reverse guide wire successfully passed the CTO lesion, and 1 case failed to establish PCI track through microcatheter. The success rate of wearing microcatheter was 98.6%. Twelve cases of reverse PCI failure due to: reverse guide wire can not pass collateral circulation in 10 cases, can not pass CTO lesions in 2 cases. Conclusion Micro-catheter technique is a safe and effective method for penetrating microcatheter in vivo. It can be used as one of the conventional methods to establish PCI track in reverse PCI.