Muramatsu Toshiya, Tsukahara Reiko, Ito Yoshiaki
Division of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 36-1 Shimosueyoshi, Tsurumi, Yokohama-shi, Kanagawa 230012 Japan.
J Invasive Cardiol. 2010 Sep;22(9):E179-82.
Percutaneous coronary intervention (PCI) was performed for a chronic total occlusion (CTO) of the right coronary artery (RCA) in a 77-year-old male patient. A guidewire could not be passed through the vessel using the antegrade approach, so we tried the retrograde approach via a collateral septal channel. A Fielder FC guidewire (Asahi Intecc Co. Ltd., Aichi, Japan) was passed through the septal channel, and a Corsair catheter (Asahi Intecc) was advanced to the distal side of the CTO in the RCA. However, the guidewire could not be advanced from the false lumen to the true lumen using the kissing-wire technique (KWT) or the reverse controlled antegrade retrograde tracking (CART) technique. Therefore, we retracted the Corsair channel dilator for a #4PD and tried to advance the antegrade Conquest Pro guidewire (Asahi Intecc) from a straight subintimal site into the retrograde channel dilator catheter. After several attempts, the antegrade Conquest guidewire successfully entered the retrograde channel dilator catheter. Subsequently, a Cypher stent (Cordis Corp., Miami Lakes, Florida) was successfully placed. The "rendezvous in coronary" technique was useful for this CTO patient, in whom it was difficult to advance a guidewire into the true lumen by the KWT and CART techniques during the retrograde approach.
对一名77岁男性患者的右冠状动脉（RCA）慢性完全闭塞（CTO）病变进行了经皮冠状动脉介入治疗（PCI）。使用正向入路无法将导丝穿过血管，因此我们尝试通过间隔侧支通道采用逆向入路。一根Fielder FC导丝（日本爱知县旭化成株式会社）穿过间隔通道，然后将一根Corsair导管（旭化成株式会社）推进到RCA中CTO病变的远端。然而，使用双导丝吻合法（KWT）或逆向控制性正向-逆向内膜下寻径技术（CART）无法将导丝从假腔推进到真腔。因此，我们将Corsair通道扩张器回撤至4PD，并尝试将正向Conquest Pro导丝（旭化成株式会社）从一个直线型内膜下部位推进到逆向通道扩张器导管内。经过多次尝试，正向Conquest导丝成功进入逆向通道扩张器导管。随后，成功置入了一枚Cypher支架（美国佛罗里达州迈阿密湖科迪斯公司）。“冠状动脉会师”技术对这名CTO患者很有用，在逆向入路过程中，通过KWT和CART技术很难将导丝推进到真腔。
