Lee Hsin-Fu, Chou Shing-Hsien, Tung Ying-Chang, Lin Chia-Pin, Ko Yu-Shien, Chang Chi-Jen
Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital.
Cardiovascular Intervention Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Acta Cardiol Sin. 2018 Jan;34(1):31-36. doi: 10.6515/ACS.201801_34(1).20170806A.
This study aims to analyze the lesion characteristics of bifurcations that required reverse wire technique and the efficacy and safety of this technique in approaching branches with a highly angulated take-off.
We enrolled patients in whom reverse wire technique was used after failed conventional antegrade wiring with the support of a Crusade catheter. The study endpoints were the technical success defined as succeeding in sending the reversely bent wire to the targeted branches without complications and the procedural success defined as succeeding in revascularization of the bifurcation lesions without complications.
Among 158 patients with bifurcation lesions undergoing percutaneous coronary intervention using a Crusade catheter to facilitate wiring, 23 (14.6%) requiring the reverse wire technique in an attempt to access branches of the bifurcation lesions with an acutely angulated take-off were enrolled for analysis. The obtainable angle of take-off was 162.9 ± 4.7 degrees. For the parent vessel, the ostium of the targeted branch, and nontargeted branch, the minimal luminal diameters were 0.3 ± 0.5 mm, 0.4 ± 0.2 mm, and 1.8 ± 0.5 mm, respectively; the diameter stenosis were 88.8 ± 18.5%, 83.0 ± 7.3%, and 32.0 ± 14.5%, respectively. Technical and procedural success was achieved in 22 cases (96% for both).
We showed in the present study that the reverse wire technique is effective and safe for approaching highly angulated branches of bifurcation lesions and consequently for complete revascularization of difficult bifurcation lesions.
本研究旨在分析需要采用逆向导丝技术的分叉病变特征，以及该技术在处理呈高角度发出分支的血管时的有效性和安全性。
我们纳入了在Crusade导管辅助下常规顺向导丝置入失败后采用逆向导丝技术的患者。研究终点包括技术成功（定义为将逆向弯曲的导丝成功送至目标分支且无并发症）和手术成功（定义为分叉病变成功血运重建且无并发症）。
在158例使用Crusade导管辅助进行经皮冠状动脉介入治疗的分叉病变患者中，有23例（14.6%）因尝试进入呈锐角发出分支的分叉病变分支而需要采用逆向导丝技术并纳入分析。可获得的分支发出角度为162.9±4.7度。对于主血管、目标分支开口处和非目标分支，最小管腔直径分别为0.3±0.5毫米、0.4±0.2毫米和1.8±0.5毫米；直径狭窄率分别为88.8±18.5%、83.0±7.3%和32.0±14.5%。22例（技术成功和手术成功均为96%）取得了技术和手术成功。
我们在本研究中表明，逆向导丝技术对于处理分叉病变呈高角度的分支以及因此对于复杂分叉病变的完全血运重建是有效且安全的。
