ZHANG Bin, LIAO Hong-tao, JIN Li-Jun, YAN Hong, DONG Tai-ming, WU Han-dong, YU Hui-min, CHAI Ren-jie
Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Gereral Hospital, Guangzhou 510100, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Sep;38(9):794-7.
to explore the feasibility of percutaneous recanalization by retrograde approach via epicardial collaterals.
retrograde percutaneous coronary intervention (PCI) via epicardial collaterals was performed in 5 patients with previously failed antegrade PCI from April 2009 to November 2009. 7 F guiding catheters were engaged in donor artery. Hydrophilic wires and microcatheters were crossed to the distal ends of chronic total occlusion (CTO) lesions via epicardial collaterals. Four retrograde wires were exchanged into stiffer wires and further crossed the CTO, eventually went into the 6 F antegrade guiding catheters and were jailed by a 2.5 mm balloon. After dilatations of retrograde balloons, the lesions were crossed by antegrade wires, and finalized by conventional PCI method. One case was recanalized with retrograde wire trapping technique and another case was recanalized by reverse CART technique.
the epicardial collaterals were reached from left anterior descending branch (LAD) to distal right coronary artery (RCA) via apex in 3 patients, from left circumflex branch via left atrium branch to posterior descending artery and RCA in 1 patient and from obtuse marginal artery to diagonal artery and LAD in 1 patient. CTO was successfully recanalized and stents were implanted in 4 patients and failed in 1 patient despite successful wire positioning to the distal end of CTO. There was no procedure-induced cardiovascular event in all cases.
epicardial collaterals may not be used as a routine route in retrograde approach PCI due to the potential risk of myocardial rupture and pericardial tamponade. In some cases with unavailable or unsuitable septal collaterals, epicardial collaterals may be used as an alternative route for CTO recanalization.
探讨经心外膜侧支循环逆行途径进行经皮再通的可行性。
2009年4月至2009年11月，对5例既往顺行冠状动脉介入治疗（PCI）失败的患者行经心外膜侧支循环逆行PCI。将7F引导导管插入供血动脉。通过亲水导丝和微导管经心外膜侧支循环穿过慢性完全闭塞（CTO）病变的远端。将4根逆行导丝换成更硬的导丝，进一步穿过CTO，最终进入6F顺行引导导管，并用2.5mm球囊将其锚定。逆行球囊扩张后，用顺行导丝穿过病变，并用传统PCI方法完成操作。1例采用逆行导丝圈套技术再通，1例采用反向CART技术再通。
3例患者的心外膜侧支循环从左前降支（LAD）经心尖到达右冠状动脉（RCA）远端，1例从左旋支经左房支到达后降支和RCA，1例从钝缘支到达对角支和LAD。4例患者CTO成功再通并植入支架，1例尽管导丝成功定位到CTO远端但再通失败。所有病例均未发生手术诱发的心血管事件。
由于存在心肌破裂和心包填塞的潜在风险，心外膜侧支循环可能不作为逆行途径PCI的常规路径。在一些间隔侧支循环不可用或不合适的情况下，心外膜侧支循环可作为CTO再通的替代途径。
