Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy.
Catheter Cardiovasc Interv. 2019 Feb 15;93(3):436-439. doi: 10.1002/ccd.27873. Epub 2018 Sep 23.
A 52-year-old male underwent percutaneous coronary intervention (PCI) using rotational atherectomy (RA: 1.5-mm burr) for a severely calcified lesion in the proximal to mid obtuse marginal (OM) branch. Even with 7 Fr extra back-up guiding catheter via femoral access, the burr could not cross the lesion due to insufficient back-up support. In order to achieve stronger back-up support, we kept the burr at the position in the OM branch and placed a supportive wire in left anterior descending artery through the side of drive-shaft sheath of the Rotablator, which sufficiently stabilized the guiding catheter during the ablation and the burr crossed the lesion. This case demonstrates that a simple technique of placing additional supportive wire in the other vessel during RA could be an effective and safe solution to facilitate improved back-up support without necessity to change the PCI system used already.
一位 52 岁男性因前降支近中段严重钙化病变而行经皮冠状动脉介入治疗（PCI），采用旋磨（RA：1.5mm 转头）。即使经股动脉途径使用 7Fr 额外的支撑导管，由于支撑不足，转头仍无法通过病变部位。为了获得更强的支撑，我们将转头保留在 OM 分支的位置，并通过旋磨头的侧支将一根支撑导丝置于前降支，在消融过程中充分稳定了指引导管，转头顺利通过病变部位。本病例表明，在 RA 过程中于另一血管内置入额外支撑导丝的简单技术，可能是一种有效且安全的解决方案，可以在不改变已使用的 PCI 系统的情况下，改善支撑，增加后盾支持。
