Dervan J P, McKay R G, Baim D S
Cathet Cardiovasc Diagn. 1985;11(2):207-12. doi: 10.1002/ccd.1810110213.
Of 84 consecutive patients referred for coronary angioplasty, an exchange length (260 cm) guide wire was used in 17 (20%) to allow serial passage of different sized dilatation catheters. Exchanges were performed for the following reasons: 1) inability to cross the stenotic segment with a full-sized dilatation catheter, with exchange for a smaller catheter to permit initial dilatation followed by a second exchange to reintroduce the full-sized balloon catheter; 2) premeditated initial use of a low-profile balloon catheter in severe stenosis, with subsequent exchange to a full-sized balloon catheter; 3) inability to achieve a satisfactory reduction of the transstenotic gradient or angiographic stenosis with the initial dilation catheter, requiring subsequent passage of a larger balloon catheter into the partially dilated segment. Eighteen of 19 attempted exchanges and 18 of 19 angioplasty procedures were completed successfully. The use of exchange guide wires permits multiple recrossings of a dilated segment, allows safe serial passage of different sized balloon catheters, and obviates the need for renegotiating difficult proximal coronary anatomy. The exchange guide wire techique can be applied safely and effectively to coronary angioplasty and provides an additional option in the successful completion of movable guide wire angioplasty procedures.
在连续接受冠状动脉成形术的84例患者中，17例（20%）使用了长度为260 cm的交换导丝，以便不同尺寸的扩张导管能连续通过。进行交换的原因如下：1）无法用全尺寸扩张导管穿过狭窄段，先换用较小的导管进行初始扩张，然后再次交换以重新引入全尺寸球囊导管；2）在严重狭窄时预先决定先使用低轮廓球囊导管，随后再换用全尺寸球囊导管；3）用初始扩张导管无法使跨狭窄梯度或血管造影狭窄得到满意降低，需要随后将更大的球囊导管送入部分扩张的节段。19次交换尝试中有18次成功完成，19例血管成形术中有18例成功完成。使用交换导丝可使扩张节段多次重新穿过，能安全地连续通过不同尺寸的球囊导管，并且无需再次处理困难的冠状动脉近端解剖结构。交换导丝技术可安全有效地应用于冠状动脉成形术，并为成功完成可移动导丝血管成形术提供了额外选择。
