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背景和目的:冠状动脉口部病变的经皮冠状动脉介入(PCI)治疗手术操作难度大,易有并发症,既要支架准确植入口部病变,又要边支不受压。本研究探讨解决这一难题的Szabo技术的成功率、安全性和可行性。方法:Szabo技术是利用边支导丝(抛锚导丝)穿过支架最靠近边支的支架网眼,防止支架前进时停止在口部病变外,保证主支导丝穿过支架腔。作者回顾性分析利用Szabo技术治疗39例病人冠状动脉口部病变的结果。手术操作成功定义:支架没有脱落,边支导丝没有退出。造影成功定义:支架准确植入到口部,而边支没有受压。血管内超声定义成功:支架准确植入到口部,近段没有突出,支架完全覆盖病变。39例病人中,男性28例,女性11例,年龄43～79,平均(65±12)岁。6F和7F指引导管分别用于35例(89.7%)和4(10.3%)例病人。经桡动脉途径31(79.5%)例和经股动脉途径8(20.5%)例。病变相关血管:前降支(LAD)26(66.7%)例,右冠(RCA)5(12.8%)例,旋支及钝缘支(LCX-OM)3(7.7%)例,后降支(PDA)5(12.8%)例。支架植入后30(76.9%)例病变相关血管和9(23.1%)例边支血管经过了血管内超声(IVUS)检查。结果:手术操作成功:36例(92.3%),这36例造影均成功(100%)。IVUS检测:支架准确植入口部者96.7%(29例/30例),支架近段轻度凸出的只有1例(3.3%)。没有发生严重并发症。结论:结果说明Szabo技术用于冠状动脉口部病变PCI成功率很高,是安全和可行的,值得推广。
BACKGROUND & OBJECTIVE: Percutaneous coronary intervention (PCI) in the treatment of oral lesions of the coronary artery is a difficult and complicated operation. It is necessary to insert the stent accurately in the oral lesions and maintain the pressure of the branches. This study explores the success, safety and viability of Szabo’s technology that addresses this challenge. METHODS: The Szabo technique uses a side guide wire (anchor guide wire) to pass through the mesh of the stent closest to the side branch to prevent it from slipping out of the mouth while advancing to ensure that the main guide wire passes through the stent cavity. The authors retrospectively analyzed the results of Szabo’s technique for the treatment of coronary ostial lesions in 39 patients. Surgical operation was successfully defined: the stent did not fall off and the side branch guide wire did not exit. Successful definition of angiography: stent accurately implanted in the mouth, while the border is not under pressure. The definition of intravascular ultrasound was successful: the stent was accurately implanted into the mouth, the proximal segment did not protrude, and the stent completely covered the lesion. Among the 39 patients, 28 were males and 11 were females, ranging in age from 43 to 79 with an average of (65 ± 12) years. 6F and 7F guide catheters were used in 35 (89.7%) and 4 (10.3%) patients, respectively. Transradial approach 31 (79.5%) and the femoral artery approach 8 (20.5%) cases. Lesions: 26 (66.7%) had LAD, 5 (12.8%) had RCA, 3 (7.7%) had LCX-OM, (PDA) 5 (12.8%) cases. Thirty (76.9%) of the lesions and 9 (23.1%) of the side branches of the vessel after stent implantation underwent an intravascular ultrasound (IVUS) examination. Results: The operation was successful: 36 cases (92.3%) were successful in this study (100%). The IVUS test showed that 96.7% (29 cases / 30 cases) of the implants were correctly implanted in the mouth, and only 1 case (3.3%) had mild bulging in the proximal part of the scaffold. No serious complications occurred. Conclusion: The results show that Szabo technology for coronary artery disease with high PCI success rate is safe and feasible, it is worth promoting.