Liu Xiaogang, Zhang Jing, Zhang Hong, Zhang Peng, Fu Naikuan
Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Front Cardiovasc Med. 2022 Feb 9;9:814492. doi: 10.3389/fcvm.2022.814492. eCollection 2022.
With the development of specialized equipment and the retrograde technique, success rates for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) have increased from 60 to 90% in the past 10 years. Performing PCI a collateral channel from the contralateral artery, using two guiding catheters, is usually the preferred approach to retrograde CTO-PCI. In the case described in this report, only the ipsilateral septal collateral artery from the proximal occluded left anterior descending (LAD) artery was available. The procedure can be performed successfully from radial artery access using a single guiding catheter.
A 57-year-old patient, with a history of anterior and inferior myocardial infarction and previous PCI, underwent a planned coronary arteriography due to his complaints of typical angina symptoms. Coronary angiography revealed stent occlusion located mid-LAD and severe in-stent restenosis in the distal right coronary artery (RCA). A proximal septal branch was supplying the distal LAD retrogradely. After repeated failed attempts at antegrade PCI for the LAD's CTO, the retrograde approach was tried. This intervention finally succeeded through the ipsilateral septal collateral. It was performed a single radial-artery access throughout the whole process. Post-operatively, the patient had no complications and was stable at 1-year follow-up.
The transradial approach to retrograde PCI for CTO an ipsilateral septal collateral using a single guiding catheter is feasible and safe in appropriately selected cases.
随着专业设备和逆行技术的发展，在过去10年中，慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）成功率已从60%提高到90%。使用两根引导导管，经对侧动脉的侧支通道进行PCI，通常是逆行CTO-PCI的首选方法。在本报告所述的病例中，仅存在来自近端闭塞的左前降支（LAD）动脉的同侧间隔侧支动脉。使用单个引导导管经桡动脉入路即可成功完成该手术。
一名57岁患者，有前壁和下壁心肌梗死病史及既往PCI史，因典型心绞痛症状就诊，接受了计划性冠状动脉造影。冠状动脉造影显示LAD中段支架闭塞，右冠状动脉（RCA）远端严重支架内再狭窄。一支近端间隔分支逆行供血至LAD远端。在对LAD的CTO进行顺行PCI多次尝试失败后，尝试了逆行方法。该干预最终通过同侧间隔侧支成功完成。整个过程均经单一桡动脉入路进行。术后，患者无并发症，1年随访时情况稳定。
在适当选择的病例中，使用单个引导导管经桡动脉入路对CTO通过同侧间隔侧支进行逆行PCI是可行且安全的。
