Grollier G, Commeau P, Foucault J P, Potier J C
Service de Cardiologie, CHU Côte de Nacre, Caen, France.
Am Heart J. 1987 Dec;114(6):1324-8. doi: 10.1016/0002-8703(87)90532-1.
Eighteen patients with chronic totally occluded coronary arteries underwent percutaneous coronary angioplasty. Eleven of these patients had a proximal occlusion of the left anterior descending artery and seven had occlusion of either the proximal or middle right coronary artery. All patients had severe angina pectoris with clearly positive results of stress treadmill testing. Preservation of a viable myocardium despite an occluded artery was, in each instance, the result of excellent collateral flow arising from the contralateral coronary artery. The guide wire and the dilatation balloon were properly positioned by opacifying the distal segment of the occluded artery by injection of contrast into the contralateral artery in 15 of 18 patients. Almost simultaneous injection, first into the contralateral vessel and then into the occluded artery, allowed evaluation of the true length of the occlusion. Contralateral opacification disappeared immediately after adequate recanalization and reappeared during inflation of the balloon. These examples show that in patients with chronic coronary occlusion, opacification of the distal segment by injection of contrast into the contralateral vessel seems to be helpful and without risk to the patient.
18例冠状动脉慢性完全闭塞患者接受了经皮冠状动脉腔内血管成形术。其中11例患者左前降支近端闭塞，7例患者右冠状动脉近端或中段闭塞。所有患者均有严重心绞痛，运动平板试验结果明显阳性。尽管动脉闭塞，但在每种情况下，存活心肌得以保留是对侧冠状动脉产生良好侧支循环的结果。18例患者中有15例通过向对侧动脉注射造影剂使闭塞动脉远端显影，从而正确放置导丝和扩张球囊。几乎同时进行注射，先注入对侧血管，然后注入闭塞动脉，这样可以评估闭塞的真实长度。充分再通后，对侧显影立即消失，球囊扩张时又重新出现。这些例子表明，对于冠状动脉慢性闭塞患者，向对侧血管注射造影剂使远端显影似乎是有益的，且对患者没有风险。
