Masutani Motomaru, Yoshimachi Fuminobu, Matsukage Takashi, Ikari Yuji, Saito Shigeru
Hyogo College of Medicine, Nishinomiya, Japan.
Indian Heart J. 2008 Jan-Feb;60(1 Suppl A):A22-6.
Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are 0.014 inch-compatible. The size of common guiding catheters is 6-F or 7-F. However, PCI requires oral administration of antiplatelet agents, and punctured-site complications such as hemorrhage and hematoma occur more frequently with use of a 6-F or 7-F guiding catheter compared to a 5-F guiding catheter. Moreover, 6-F or larger guiding catheters may cause radial arterial occlusion, although the transradial approach causes less punctured-site complications compared to the transfemoral approach. Recently, 0.010-inch guidewires applicable for the Kissing Balloon Technique (KBT) using a 5-F guiding catheter and 0.010-inch guidewire-compatible balloons have been developed in Japan, and a 3-F angiography catheter has also been developed. We refer to these devices as the "Slender System", and we have used this system for active treatment of bifurcation lesions and chronic total occlusion (CTO). In this report, we describe angiography using a 3-F catheter, the KBT using a 5-F guiding catheter and 0.010-inch guidewires, and treatment of CTO using a 5-F catheter and 0.010-inch guidewires. For CTO treated using the Slender System at our facility, the transradial arterial approach was used in 96% of cases, treatment using the Slender System alone succeeded in 68%, and the overall success rate was 89%. Therefore, our results show that complex lesions may be treatable using the Slender System, and that not all complex lesions require a 6-F or larger guiding catheters, a femoral arterial approach, or bilateral guiding catheters.
目前，0.014英寸的导丝常用于冠状动脉介入治疗，所有器械均与0.014英寸兼容。常见的引导导管尺寸为6F或7F。然而，经皮冠状动脉介入治疗（PCI）需要口服抗血小板药物，与5F引导导管相比，使用6F或7F引导导管时，穿刺部位并发症如出血和血肿的发生频率更高。此外，6F或更大尺寸的引导导管可能会导致桡动脉闭塞，尽管经桡动脉途径与经股动脉途径相比，穿刺部位并发症较少。最近，日本已开发出适用于使用5F引导导管和0.010英寸导丝的亲吻球囊技术（KBT）的0.010英寸导丝，以及3F血管造影导管。我们将这些器械称为“纤细系统”，并已使用该系统积极治疗分叉病变和慢性完全闭塞（CTO）。在本报告中，我们描述了使用3F导管进行血管造影、使用5F引导导管和0.010英寸导丝进行KBT以及使用5F导管和0.010英寸导丝治疗CTO的情况。在我们机构使用纤细系统治疗的CTO病例中，96%采用经桡动脉途径，仅使用纤细系统治疗成功的比例为68%，总体成功率为89%。因此，我们的结果表明，使用纤细系统可能可以治疗复杂病变，并非所有复杂病变都需要6F或更大尺寸的引导导管、股动脉途径或双侧引导导管。
