Huang Wei-Chieh, Teng Hsin-I, Hsueh Chien-Hung, Lin Shing-Jong, Chan Wan-Leong, Lu Tse-Min
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
Division of Cardiology, Chiayi&WanQiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
J Interv Cardiol. 2018 Oct;31(5):572-579. doi: 10.1111/joic.12518. Epub 2018 May 3.
The successful recanalization rate of chronic total occlusion (CTO) lesions without retrograde collaterals available is always low. Intravascular ultrasound (IVUS) may be useful to guide the subintimal guidewire to re-enter the true lumen. We evaluated the clinical feasibility and efficacy of the IVUS-guided wiring re-entry technique for these complex CTO lesions.
Twenty consecutive patients (19 male, mean age: 65.3 ± 12.8 years) with both failed antegrade and retrograde approaches were enrolled. The IVUS catheter was introduced into the subintimal space to identify the entry point into the subintimal space, and guide another stiff wire to re-enter the true lumen with the adjacent side-branch or first wire as markers, or using IVUS-guided parallel wire technique.
The entry point into the subintimal space was identified by IVUS in all cases, and the IVUS-guided wiring re-entry technique succeeded in 17 cases (85%). No procedure-related complication was noted except one case of delayed cardiac tamponade due to the wire perforation. During the mean follow-up period of 1.9 ± 1.3 years, there was no adverse cardiac event, except one patient died of the complication of cardiac transplantation.
The IVUS-guided wiringre-entry technique might be feasible and safe for the recanalization of complex CTO lesions.
对于没有可用逆行侧支的慢性完全闭塞（CTO）病变，其成功再通率一直很低。血管内超声（IVUS）可能有助于引导内膜下导丝重新进入真腔。我们评估了IVUS引导下的导丝重新进入技术对这些复杂CTO病变的临床可行性和有效性。
连续纳入20例顺行和逆行入路均失败的患者（19例男性，平均年龄：65.3±12.8岁）。将IVUS导管插入内膜下间隙以确定进入内膜下间隙的入口点，并以相邻侧支或第一根导丝为标记，或使用IVUS引导的平行导丝技术引导另一根硬导丝重新进入真腔。
所有病例均通过IVUS确定了进入内膜下间隙的入口点，IVUS引导下的导丝重新进入技术在17例（85%）中成功。除1例因导丝穿孔导致延迟性心脏压塞外，未发现与手术相关的并发症。在平均1.9±1.3年的随访期内，除1例患者死于心脏移植并发症外，无不良心脏事件发生。
IVUS引导下的导丝重新进入技术对于复杂CTO病变的再通可能是可行且安全的。
