Institute of Cardiology, Catholic University of Sacred Heart, Largo Gemelli 1, Rome, Italy.
EuroIntervention. 2010 Dec;6 Suppl J:J72-80. doi: 10.4244/EIJV6SUPJA12.
Safe guidewire placement in the main vessel (MV) and in the side branch (SB) does represent the key point for successful percutaneous coronary interventions (PCI) in bifurcated lesions. During bifurcation PCI, SB wiring is systematically performed as a first step and is often repeated ("rewiring") during the procedure in order to treat the SB after MV stenting. Wiring and rewiring are crucial phases of bifurcation PCI which require, in the most complex cases, specific operator experience. In the present paper, the classic SB wiring techniques necessary for routine bifurcation interventions (antegrade and pullback wiring technique) as well as "advanced" wiring techniques ("reverse wire" technique, Venture-facilitate wiring, MV balloon predilation or debulking) are described. Moreover, the rewiring technique is discussed in detail, with particular attention on the tips and tricks which may facilitate the achievement of optimal result with provisional stenting (pullback rewiring) and help manage bail out situations like acute SB flow impairment after MV stenting.
在主血管（MV）和侧支（SB）中安全地放置导丝是成功进行分叉病变经皮冠状动脉介入治疗（PCI）的关键。在分叉 PCI 期间，SB 导丝通常作为第一步进行系统操作，并且在 MV 支架置入后处理 SB 时经常重复（“重新布线”）。导丝和重新布线是分叉 PCI 的关键阶段，在最复杂的情况下，需要特定的操作经验。在本文中，描述了常规分叉介入所需的经典 SB 布线技术（顺行和回撤布线技术）以及“高级”布线技术（“反向导丝”技术、Venture 辅助布线、MV 球囊预扩张或减容）。此外，详细讨论了重新布线技术，特别关注可能有助于实现临时支架置入的最佳效果的技巧和窍门（回撤重新布线），并有助于处理 MV 支架置入后急性 SB 血流受损等救生情况。
