Lichaa Hady
Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, Tennessee, USA.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):E977-E984. doi: 10.1002/ccd.29940. Epub 2021 Aug 31.
In patients with renal insufficiency, advanced techniques have been described to achieve ultra-low contrast or zero contrast percutaneous coronary interventions (PCI). However, these techniques use intra-coronary imaging before stent placement to determine adequate landing zones, by correlating them with saved fluoroscopic landmarks. Still, this leaves the operator with a certain degree of uncertainty about the exact lesion coverage, which is checked with post-stent intra-coronary imaging. We hereby describe a novel technique which takes away the concern of uncertainty regarding stent-landing zones and allows for the highest amount of precision in stent positioning, arguably even better than with the use of angiography. This technique involves positioning coronary stents under the live guidance of an intravascular ultrasound (IVUS) catheter which is positioned simultaneously, side by side to a stent. This technique takes advantage of all the benefits of IVUS based PCI without losing the precision in stent positioning when compared to traditional angiography. It simplifies the application of low contrast PCI by the interventional cardiology community, while maintaining the confidence in precise stenting. It has also the potential to decrease the incidence of contrast-induced nephropathy, hence procedural morbidity, while allowing for optimal long-term image based PCI outcomes. Obviously, it applies to moderate or larger coronary segments, without significant tortuosity. It also comes at the expense of slightly larger guide catheters, which is compensated for by the use of thin walled sheaths or sheathless catheter systems. Finally, radial access is still applicable depending on radial artery size and available equipment.
在肾功能不全患者中，已有先进技术被描述用于实现超低造影剂或零造影剂的经皮冠状动脉介入治疗（PCI）。然而，这些技术在支架置入前使用冠状动脉内成像，通过将其与保存的荧光透视标记相关联来确定合适的着陆区。即便如此，这仍使操作者对确切的病变覆盖范围存在一定程度的不确定性，需通过支架置入后的冠状动脉内成像进行检查。我们在此描述一种新技术，该技术消除了对支架着陆区不确定性的担忧，并在支架定位方面实现了最高程度的精确性，甚至可以说比使用血管造影术更好。这项技术包括在血管内超声（IVUS）导管的实时引导下定位冠状动脉支架，IVUS导管与支架并排同时定位。与传统血管造影术相比，该技术利用了基于IVUS的PCI的所有优点，同时在支架定位方面不失精确性。它简化了介入心脏病学界应用低造影剂PCI的操作，同时保持了对精确支架置入的信心。它还有可能降低造影剂肾病的发生率，从而降低手术并发症，同时实现基于图像的最佳长期PCI结果。显然，它适用于中度或较大的冠状动脉节段，且无明显迂曲。它的代价是使用稍大的引导导管，但可通过使用薄壁鞘管或无鞘导管系统来弥补。最后，根据桡动脉大小和可用设备，仍可采用桡动脉入路。
