Division of Cardiology, Department of Internal Medicine, Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA.
Department of Internal Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA.
Cardiovasc Ther. 2017 Dec;35(6). doi: 10.1111/1755-5922.12290.
Coronary chronic total occlusions (CTOs) are commonly encountered during diagnostic angiograms. With recent advances, especially in experienced centers, success rates with CTO percutaneous coronary intervention (PCI) have approached 80% or higher. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of a left circumflex artery (LCX) CTO that was successfully revascularized using a microcatheter balloon pinning technique that allowed additional wire support.
A 77-year-old woman status post-two-vessel coronary artery bypass graft surgery presented with new onset angina at rest and was found to have a patent graft to the left anterior descending artery, and an unrevascularized proximal LCX CTO. PCI was attempted with a microcatheter using an antegrade approach. This approach was unsuccessful due to the lack of support and the left circumflex angle. As a result, we used a balloon to pin the microcatheter to the wall of the left main to allow for successful wiring of the LCX. A stent was successfully deployed in the LCX, and the patient was discharged from the hospital 2 days later. At follow-up, the patient was asymptomatic and returned to her usual activity.
After conducting a thorough literature search, it appears that this is the first case that a microcatheter has been pinned with a balloon. We believe that in LCX CTOs that require support, the microcatheter pinning technique can provide adequate support in wiring CTO's. LCX CTOs can be very difficult to treat, we present a case of a LCX CTO that required the use of the microcatheter balloon pinning technique to allow additional wire support for successful wiring and ultimately treatment.
在诊断性血管造影中，常可遇到冠状动脉慢性完全闭塞（CTO）病变。随着技术的进步，尤其是在有经验的中心，CTO 经皮冠状动脉介入治疗（PCI）的成功率已接近 80%或更高。值得注意的是，尽管这些技术取得了进展，CTO 仍然难以治疗。我们报告了一例左回旋支（LCX）CTO 病例，该病例采用微导管球囊固定技术成功再通，该技术允许额外的导丝支持。
一位 77 岁女性，曾行两血管冠状动脉旁路移植术，因新发静息性心绞痛就诊，发现左前降支有通畅的搭桥血管，而近端 LCX 仍为 CTO。采用正向入路的微导管尝试进行 PCI，但由于缺乏支持和左回旋支角度问题，该方法失败。因此，我们使用球囊将微导管固定在左主干壁上，以便成功对 LCX 进行布线。LCX 中成功置入支架，患者于 2 天后出院。随访时，患者无症状并恢复正常活动。
经过全面的文献检索，这似乎是首例使用球囊固定微导管的病例。我们认为，在需要支持的 LCX CTO 中，微导管固定技术可以为布线 CTO 提供足够的支持。LCX CTO 非常难以治疗，我们报告了一例 LCX CTO 病例，需要使用微导管球囊固定技术，以便为成功布线和最终治疗提供额外的导丝支持。
