Wang Hong-Chao, Lu Wei, Gao Zi-Han, Xie Ya-Nan, Hao Jie, Liu Jin-Ming
Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
Department of Cardiology, The Third Hospital of Shijiazhuang City, Shijiazhuang 050000, Hebei Province, China.
World J Clin Cases. 2021 Apr 26;9(12):2751-2762. doi: 10.12998/wjcc.v9.i12.2751.
In transradial intervention procedures, poor back-up support and noncoaxial alignment of the guide catheter (GC) may result in failure of the balloon or stent to reach the targeted lesion. Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications. A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.
To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions the radial access.
A total of 135 patients with type B2/C nonocclusive lesions who were treated the transradial approach were enrolled in the study. The clinical characteristics, indications for use of the rapid exchange extension catheter, and procedural details and results were reviewed and analyzed. All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.
The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity (37.8%), followed by heavy calcification (28.9%), long lesions (20.0%), proximal stent (6.7%), in-stent restenosis (5.2%), and coronary origin anomalies (1.5%). The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter: Multiple predilatation technique (57%), buddy wire technique (33.4%), balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extension catheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheter service time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5 ± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success (balloon or stent successful crossing of the target lesion with this technique) was 94.8%.
The rapid exchange extension catheter technique showed acceptable safety and efficacy in the transradial coronary interventions of type B2/C nonocclusive coronary lesions. We recommend this technique to assist in complex lesion intervention radial access.
在经桡动脉介入手术中，导引导管（GC）的辅助支撑不足和同轴对准不佳可能导致球囊或支架无法到达目标病变部位。利用原有的GC和导丝提供额外辅助支撑的方法可以提高手术成功率并减少并发症。快速交换导引导管延长导管在保留初始GC和已插入导丝的同时，能提供方便且高效的辅助支撑。
评估快速交换延长导管在经桡动脉途径治疗B2/C型非闭塞性冠状动脉病变中的有效性和安全性。
本研究共纳入135例经桡动脉途径治疗的B2/C型非闭塞性病变患者。回顾并分析其临床特征、快速交换延长导管的使用指征、手术细节及结果。记录住院期间和随访期内所有与手术相关的并发症及主要不良心血管事件。
使用快速交换延长导管最常见的指征是血管迂曲（37.8%），其次是重度钙化（28.9%）、长病变（20.0%）、近端支架（6.7%）、支架内再狭窄（5.2%）和冠状动脉起源异常（1.5%）。在使用快速交换导管之前，以下技术在通过目标病变时失败：多次预扩张技术（57%）、双导丝技术（33.4%）、球囊锚定技术（5.9%）和切割球囊改良技术（3.7%）。延长导管插入的平均深度为20.56±13.05mm，快速交换导管的平均使用时间为18.9±9.7分钟。支架的平均长度和直径分别为33.5±14.4mm和2.75±0.45mm。技术成功率（使用该技术球囊或支架成功通过目标病变）的总发生率为94.8%。
快速交换延长导管技术在经桡动脉介入治疗B2/C型非闭塞性冠状动脉病变中显示出可接受的安全性和有效性。我们推荐该技术用于辅助经桡动脉途径的复杂病变介入治疗。
