Christopoulos Georgios, Kotsia Anna P, Brilakis Emmanouil S
VA North Texas Health Care System, Cardiology, 4500 South Lancaster Road, Dallas, TX 75216 USA.
J Invasive Cardiol. 2015 Sep;27(9):E199-202.
Subintimal dissection and reentry techniques are widely used in chronic total occlusion (CTO) interventions; however, inability to reenter into the distal true lumen is a common cause of failure. In some patients, subintimal hematoma may develop, compressing the lumen and hindering reentry. We describe 3 CTO cases in which the distal vessel could not be visualized after subintimal crossing, in spite of attempts to decompress the subintimal hematoma. Bidirectional "blind" puncture was performed with the Stingray wire through both ports of the Stingray balloon, followed by exchange of the Stingray wire for a Pilot 200 guidewire (the "double-blind stick-and-swap" technique) achieving distal true lumen reentry.
内膜下夹层分离和重回真腔技术广泛应用于慢性完全闭塞（CTO）介入治疗；然而，无法重回远端真腔是常见的失败原因。在一些患者中，可能会形成内膜下血肿，压迫管腔并阻碍重回真腔。我们描述了3例CTO病例，尽管尝试对内膜下血肿进行减压，但在内膜下穿过病变后仍无法看到远端血管。使用Stingray导丝通过Stingray球囊的两个端口进行双向“盲”穿刺，随后将Stingray导丝换成Pilot 200导丝（“双盲穿刺并交换”技术），成功实现远端真腔重回。
