Taniguchi Norimasa, Takahashi Akihiko, Sakamoto Shingo
Department of Cardiovascular Medicine, Sakurakai Takahashi Hospital, Ooikecho, Sumaku, Kobe, Hyogo 654-0026, Japan.
J Invasive Cardiol. 2011 Feb;23(2):84-6.
Guiding catheter-induced coronary artery dissection is a rare, but hazardous complication of percutaneous coronary intervention (PCI) and is associated with the potential risk of impairment of coronary blood flow. Therefore, occurrence of this complication mandates a prompt revascularization procedure. A 68-year-old female patient with acute myocardial infarction caused by total occlusion of the proximal right coronary artery (RCA) underwent PCI. After revascularization by thrombus aspiration, catheter-induced dissection of the ostium of the right coronary artery (RCA) occurred when the guiding catheter and guidewire were accidentally removed. An attempt to engage the guiding catheter and guidewire into the true lumen failed because of total occlusion of the right coronary ostium. A chronic total occlusion (CTO)-dedicated guidewire was then used to create a fenestration of the intimal flap, and after it penetrated into the distal true lumen, a low-profile balloon catheter was dilated, and coronary flow from the false to the true lumen was established. After balloon dilatation, stents were deployed at both the dissection site and in the distal lesion. The final angiogram revealed restoration of coronary blood flow. We propose that application of a CTO-dedicated guidewire to create a fenestration of the intimal flap in the region of the coronary dissection is a feasible and effective alternative to conventional procedures.
引导导管导致的冠状动脉夹层是经皮冠状动脉介入治疗（PCI）中一种罕见但危险的并发症，与冠状动脉血流受损的潜在风险相关。因此，这种并发症的发生需要立即进行血运重建手术。一名68岁女性患者因右冠状动脉（RCA）近端完全闭塞导致急性心肌梗死，接受了PCI治疗。在通过血栓抽吸进行血运重建后，当意外移除引导导管和导丝时，发生了右冠状动脉开口处的导管导致的夹层。由于右冠状动脉开口完全闭塞，尝试将引导导管和导丝插入真腔失败。然后使用一根慢性完全闭塞（CTO）专用导丝在内膜瓣上制造一个开窗，当它穿透进入远端真腔后，扩张一根低轮廓球囊导管，建立了从假腔到真腔的冠状动脉血流。球囊扩张后，在夹层部位和远端病变处均植入了支架。最终血管造影显示冠状动脉血流恢复。我们提出，应用CTO专用导丝在冠状动脉夹层区域制造内膜瓣开窗是一种可行且有效的传统手术替代方法。
