Lancaster General Hospital and the Lancaster Heart and Stroke Foundation, Lancaster, Pennsylvania 17603, USA.
Heart Rhythm. 2010 May;7(5):634-8. doi: 10.1016/j.hrthm.2010.01.027. Epub 2010 Jan 25.
Ideally, new leads are placed via the axillary/cephalic vein on the same side as the initial implant; however, 3.6% to 9% of patients have chronic total subclavian/innominate occlusion. In most cases, a wire can be manipulated across the occlusion and venoplasty safely performed. Occasionally, a wire will not cross, and additional tools are required.
The purpose of this study was to evaluate our experience with an excimer laser catheter used to cross wire-refractory chronic total subclavian/innominate occlusion in 12 patients.
We first used the laser to successfully cross a lead-related chronic total occlusion that did not yield to either a wire or microdissection. We subsequently used the laser for 11 additional wire-refractory occlusions. We reviewed the implant reports, hospital records, and videos of each case.
The occlusions were successfully crossed and a wire placed for venoplasty in 11 of 12 cases by one of three implanting physicians. No complications occurred, and the existing leads sustained no damage.
Although the safety of the procedure remains uncertain, if directions are followed and are precautions heeded, physicians with training and experience in venoplasty and laser lead extraction can learn this technique, which provides an important option for adding a lead to an existing device when the ipsilateral access vein is occluded.
理想情况下，新的导联应通过与初始植入物同侧的腋/头静脉放置；然而，仍有 3.6%至 9%的患者存在慢性全锁骨下/无名动脉闭塞。在大多数情况下，可以安全地将导丝穿过闭塞并进行血管成形术。偶尔，导丝无法穿过，需要额外的工具。
本研究的目的是评估我们在 12 例使用准分子激光导管治疗导线难治性慢性全锁骨下/无名动脉闭塞的经验。
我们首先使用激光成功地穿过了与导联相关的慢性全闭塞，该闭塞既不能用导丝也不能用微解剖术来解决。随后，我们将激光用于另外 11 例导线难治性闭塞。我们复习了植入报告、医院记录和每个病例的视频。
在 12 例患者中，有 11 例由 3 名植入医生之一成功地穿过了闭塞，并放置了导丝进行血管成形术。没有发生并发症，并且现有的导联没有受损。
尽管该手术的安全性仍不确定，但如果遵循操作指南并注意预防措施，接受过血管成形术和激光导联提取培训和经验的医生可以学习这种技术，当同侧的静脉通路阻塞时，这为在现有设备上添加导联提供了一个重要选择。
