Takimura Hideyuki, Muramatsu Toshiya, Tsukahara Reiko
Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumiku, Yokohamashi, Kanagawaken, Japan.
J Invasive Cardiol. 2012 Jan;24(1):E5-9.
Percutaneous coronary intervention was performed for chronic total occlusion (CTO) of the right coronary artery (RCA) in a 55-year-old man. CT coronary angiography (CTCA) with a 64-slice scanner showed a large calcified plaque at the entrance to the CTO. A stent that had been implanted at the RCA ostium 10 years earlier was angled toward a side branch, suggesting that the guidewire would not reach the true lumen via the antegrade approach. Therefore, we attempted the retrograde approach via a septal collateral with the kissing wire technique. However, the guidewire failed to cross the CTO because of obstruction by the implanted stent. We next attempted the controlled antegrade and retrograde subintimal tracking technique and 2 stents were successfully deployed. In this patient, CTCA provided useful information for management of a difficult CTO.
一名55岁男性因右冠状动脉（RCA）慢性完全闭塞（CTO）接受了经皮冠状动脉介入治疗。使用64层扫描仪进行的CT冠状动脉造影（CTCA）显示CTO入口处有一个大的钙化斑块。10年前在RCA开口处植入的支架向一个侧支成角，这表明导丝无法通过顺行途径到达真腔。因此，我们尝试通过间隔侧支采用亲吻导丝技术进行逆行途径。然而，由于植入的支架造成阻塞，导丝未能穿过CTO。接下来，我们尝试了可控顺行和逆行内膜下寻径技术，并成功植入了2个支架。在该患者中，CTCA为处理困难的CTO提供了有用信息。
