Schneider Michael A E, Hoch Franz V, Neuser Hans, Brunn Jürgen, Koller Marcus L, Gietzen Frank, Schamberger Rainer, Kerber Sebastian, Schumacher Burghard
Department of Cardiology, Center of Cardiovascular Medicine, Bad Neustadt, Germany.
J Interv Cardiol. 2008 Apr;21(2):158-66. doi: 10.1111/j.1540-8183.2007.00327.x. Epub 2008 Jan 28.
Percutaneous coronary intervention (PCI) has been broadly established and often includes highly complex stenoses that require difficult navigation. The purpose of this study is to assess the feasibility of a new magnetic navigation system (MNS) to enable intracoronary guidewire deployment and PCI in daily clinical practice and to compare the 2D guidance to the virtual 3D angioscopy feature.
We included 30 consecutive patients (pt) in whom 36 coronary arteries were PCI targets. Patients were randomized to guidewire steering by either 2D guidance or virtual 3D angioscopy (33%). In 31/36 (86%) interventions the MNS guidewire successfully passed the culprit stenosis and the procedure was accomplished by PCI. In 5/30 pt an MNS multivessel intervention was performed. Three of 5 unsuccessful procedures failed due to an unsuccessful recanalization of a subtotal chronic occlusion including 1 pt who required surgical intervention. In 2/36 procedures the magnetic guided intervention was performed effectively after prior conventional failure related to complex anatomy. The contrast medium amount needed to position the magnetic guidewire was 60 +/- 101 mL in 2D accomplished interventions vs. 14 +/- 15 mL in 3D procedures (p < 0.05). In 3 pt the MNS did not harm the implanted pacemaker or defibrillator system.
Magnetic guided PCI is useful in selected patients. In our experience, success is less likely in evidence of a subtotal occlusion.
经皮冠状动脉介入治疗（PCI）已广泛开展，且常涉及需要复杂操作才能通过的高度复杂狭窄病变。本研究旨在评估一种新型磁导航系统（MNS）在日常临床实践中实现冠状动脉内导丝置入和PCI的可行性，并比较二维引导与虚拟三维血管造影功能。
我们纳入了30例连续患者，其36条冠状动脉为PCI目标血管。患者被随机分为通过二维引导或虚拟三维血管造影进行导丝操控（33%）。在36例介入操作中的31例（86%）中，MNS导丝成功通过罪犯病变狭窄处，且PCI手术完成。在5/30例患者中进行了MNS多支血管介入治疗。5例未成功的手术中有3例因次全慢性闭塞病变再通失败，其中1例患者需要手术干预。在36例操作中的2例中，在先前因解剖结构复杂导致传统方法失败后，磁导航引导介入治疗有效完成。二维引导下完成的介入操作中，定位磁导丝所需的造影剂用量为60±101 mL，而三维操作中为14±15 mL（p<0.05）。在3例患者中，MNS未对植入的起搏器或除颤器系统造成损害。
磁导航PCI对部分患者有用。根据我们的经验，次全闭塞时成功的可能性较小。
