Han Ya-ling, Li Yi, Wang Shou-li, Jing Quan-min, Ma Ying-yan, Wang Geng, Luan Bo, Wang Bin, Wang Zhu-lu, Wang Dong-mei
Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, China.
Chin Med J (Engl). 2008 Mar 20;121(6):518-21.
Failure of balloon catheter passing through the occluded segment accounts for 10% - 15% of all procedures during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing.
Between July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing.
Both overall lesion and technique success rates were 91.5% (150/164). A total of 211 crushing wires were used during PCI, including 1 crushing wire for 117 (71.3%) lesions and 2 crushing wires for 47 (28.7%) lesions. Approximately 57.3% (121/211) of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions (8.5%). Technique failure was due to crushing wires entering false lumen (92.9%, 13/14) and coronary perforation (7.1%, 1/14). Major procedural complications included coronary perforation (1 case) and severe coronary dissection (2 cases), all of which were successfully treated.
Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.
在慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）中，球囊导管无法通过闭塞段的情况占所有手术的10% - 15%。我们旨在研究一种通过多导丝斑块挤压来促进球囊导管通过的原创技术。
在2000年7月至2007年10月期间，对152例患有164处CTO病变且球囊通过失败的患者采用多导丝斑块挤压技术进行治疗。该技术的主要过程是在球囊失败后，沿着位于CTO病变真腔内的原有导丝插入1根或2根导丝进行斑块挤压，然后撤出挤压导丝以扩大闭塞段内的管腔，从而便于球囊通过。
整体病变成功率和技术成功率均为91.5%（150/164）。PCI过程中共使用了211根挤压导丝，其中117处病变（71.3%）使用1根挤压导丝，47处病变（28.7%）使用2根挤压导丝。所有挤压导丝中约57.3%（121/211）是在同一手术中已使用过的。14处病变（8.5%）出现技术失败。技术失败的原因是挤压导丝进入假腔（92.9%，13/14）和冠状动脉穿孔（7.1%，1/14）。主要手术并发症包括冠状动脉穿孔（1例）和严重冠状动脉夹层（2例），所有这些均得到成功治疗。
多导丝斑块挤压技术在CTO PCI中有效促进球囊导管通过。它可行、经济且相对安全，手术并发症发生率低。
