Vo Minh N, Ravandi Amir, Brilakis Emmanouil S
Section of Cardiology, St. Boniface Hospital, University of Manitoba, Winnipeg, Canada.
J Invasive Cardiol. 2015 May;27(5):E62-4.
Use of the retrograde approach significantly improves the success rate of chronic total occlusion (CTO) percutaneous coronary intervention. The most commonly applied retrograde technique is placing a guidewire just distal to the distal cap using collateral vessels, with subsequent retrograde crossing of the occlusive segment. This is followed by advancement of a microcatheter and externalization of a long guidewire to allow antegrade delivery of balloons and stents. However, there are occasions when a microcatheter or balloon cannot be delivered retrogradely through the occlusive segment, resulting in procedure failure. We describe the "tip-in" technique, which involves intubation of the retrograde guidewire with an antegrade microcatheter to allow successful revascularization of a CTO after failure to externalize.
逆行入路的使用显著提高了慢性完全闭塞（CTO）经皮冠状动脉介入治疗的成功率。最常用的逆行技术是利用侧支血管将导丝置于远段帽的远端，随后逆行穿过闭塞段。接着推进微导管并将长导丝引出体外，以便顺行输送球囊和支架。然而，有时微导管或球囊无法逆行通过闭塞段，导致手术失败。我们描述了“尖端插入”技术，该技术涉及用顺行微导管对逆行导丝进行插管，以便在无法引出导丝的情况下成功实现CTO血管再通。
