Finci L, Meier B, Roy P, Steffenino G, Rutishauser W
Cardiology Center, University Hospital, Geneva, Switzerland.
Cathet Cardiovasc Diagn. 1988;14(3):206-12. doi: 10.1002/ccd.1810140312.
The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.
导丝穿过球囊本身，在球囊近端穿出导管，并通过引导导管沿其小轴（3法式）并行。对61例患者的73处病变尝试使用2.0至3.7毫米的球囊进行单轨冠状动脉血管成形术。66处病变（90%）获得血管造影成功。15处病变需要更换球囊。在三处病变中，单轨球囊未能穿过病变，而标准球囊成功穿过；两处病变任何球囊都无法穿过。四名患者发生血管闭塞：两名患者接受了无梗死的急诊手术（一名在4天后突然死亡，一名在1天后发生中风），一名通过标准球囊再通，一名发生心肌梗死。持续输注尿激酶直至第3例患者，其输送系统出现问题导致心脑空气栓塞（完全康复）。在随后仅给予10000 U肝素推注的58例患者中未观察到血栓形成并发症。单轨球囊便于造影剂注射和球囊更换，但似乎更难穿过狭窄病变。省略先前推荐的溶栓剂输注被证明是安全的。
