Yamaguchi Masashi, Tanaka Yutaka, Sato Daisuke, Saito Shigeru
Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1 Kamakura, Kamakura, 247-8533Japan.
Eur Heart J Case Rep. 2024 Sep 27;8(10):ytae537. doi: 10.1093/ehjcr/ytae537. eCollection 2024 Oct.
The reverse-wiring technique (RWT) using a hairpin-bend wire is useful for percutaneous coronary intervention of a bifurcation lesion with an extremely angulated side branch (SB); however, it is not necessarily effective in some anatomical situations. We report a novel SB wiring technique, the U-turn wiring technique (UWT), that is useful for wiring an extremely angled SB proximal to the ectasia.
In the first case, the bare wire took a U-turn in the ectasia of the diagonal branch and crossed towards the angled left anterior descending artery, but a coronary dissection occurred in the diagonal branch due to the continuous wire-pushing force. Therefore, in the second case, we used a microcatheter with distal flexibility to prevent guidewire-induced vessel injury at the ectasia site and safely advanced the wire to the distal portion of the extremely angulated SB.
The UWT takes advantage of the ectasia as a space to U-turn the guidewire. The UWT does not require a hairpin-bend guidewire or a dual-lumen catheter. The guidewire can be easily pushed forward through a reversed SB. After successful wire insertion, the guidewire can be easily advanced deep into the side branch. The UWT facilitates wire crossing to a reverse-angled branch utilizing the coronary ectasia anatomy through a simple manipulation.
使用发夹弯钢丝的反向布线技术（RWT）对于经皮冠状动脉介入治疗伴有极成角侧支（SB）的分叉病变很有用；然而，在某些解剖情况下它不一定有效。我们报告一种新的SB布线技术，即U型转弯布线技术（UWT），它对于在扩张近端为极成角的SB进行布线很有用。
在第一个病例中，裸钢丝在对角支扩张处呈U型转弯并交叉至成角的左前降支，但由于持续的钢丝推送力，对角支发生了冠状动脉夹层。因此，在第二个病例中，我们使用了具有远端柔韧性的微导管，以防止导丝在扩张部位引起血管损伤，并将钢丝安全地推进到极成角SB的远端部分。
UWT利用扩张作为导丝进行U型转弯的空间。UWT不需要发夹弯导丝或双腔导管。导丝可以很容易地通过反向的SB向前推送。成功插入钢丝后，导丝可以很容易地深入侧支。UWT通过简单的操作利用冠状动脉扩张解剖结构促进钢丝穿过至反向成角分支。
