Worley Seth J, Gohn Douglas C, Pulliam Robert W
Heart Center - Lancaster General Hospital and the Lancaster Heart and Stroke Foundation, Lancaster, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2009 Dec;32(12):1577-81. doi: 10.1111/j.1540-8159.2009.02573.x. Epub 2009 Oct 10.
Venous anatomy frequently impairs placement of the left ventricular (LV) lead. In some cases, the wire will not advance into the vein and in others wire position is lost as the lead is advanced. This article describes how a commonly available goose neck snare is used to gain access to the distal end of the wire as it re-enters the coronary sinus retrograde via collaterals through an adjacent vein. The snare is advanced into the coronary sinus through the same catheter as the wire. The snare opens perpendicular to the long axis of the coronary sinus due to which the wire must pass through the open loop, provided the diameter of the snare is approximately the same as the coronary sinus. Thus no time-consuming manipulation of the snare is required. With access to both ends of the wire the vein is approached either retrograde (over the distal end) or antegrade (over the proximal end) while the other end of the wire is secured by the operator. Gaining control of both ends of the wire with a snare is another example of adapting interventional techniques for the device implantation. Unlike venoplasty, the snare does not evoke credentialing concerns and can be easily implemented by most implanting physicians.
静脉解剖结构常常会影响左心室（LV）导线的植入。在某些情况下，导线无法进入静脉，而在其他情况下，随着导线的推进，导线位置会丢失。本文描述了如何使用一种常见的鹅颈圈套器，当导线通过侧支经相邻静脉逆行重新进入冠状静脉窦时，获取导线远端。圈套器与导线通过同一导管推进到冠状静脉窦。圈套器垂直于冠状静脉窦的长轴打开，只要圈套器的直径与冠状静脉窦大致相同，导线就必须穿过开放环。因此，无需对圈套器进行耗时的操作。在获得导线两端的通路后，在操作者固定导线另一端的同时，可逆行（越过远端）或顺行（越过近端）接近静脉。用圈套器控制导线两端是将介入技术应用于器械植入的另一个例子。与静脉成形术不同，圈套器不会引发资质认证问题，大多数植入医生都能轻松实施。
