Bruce Christopher G, Halaby Rim N, Khan Jaffar M, Rogers Toby, Jaimes Andrea E, Babaliaros Vasilis C, Greenbaum Adam B, Lederman Robert J
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., R.N.H., A.E.J., R.J.L.).
St Francis Hospital and Heart Center, Roslyn, NY (J.M.K.).
Circ Cardiovasc Interv. 2025 Jul 30:e015459. doi: 10.1161/CIRCINTERVENTIONS.125.015459.
Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement. Current techniques (transcatheter leaflet modification or snorkel stenting) cannot prevent obstruction in all cases.
We created a transcatheter coronary artery bypass procedure, VECTOR (Ventriculo-Coronary Transcatheter Outward Navigation and Re-Entry), to bypass the proximal coronary artery with a covered stent graft. We tested the feasibility of creating a neo-ostium, 10 to 15 mm cephalad to the native, and bypassing the proximal coronary artery in swine. We established a proximal anastomosis using transcatheter electrosurgery to exit the aorta to the pericardium. The distal anastomosis was created using a guidewire to exit the proximal coronary artery and enter the pericardium. The points were connected, and a covered stent graft implanted to bypass the proximal vessel. Coronary angiography and intravascular ultrasound were used to assess graft patency and expansion.
The VECTOR technique was developed in 11 and performed on the right coronary artery in 6 additional healthy swine. Proximal and distal anastomoses were successfully created, and up to 3 (total length 40 [35-45] mm) covered stent grafts were delivered to bypass the proximal vessel. There were no significant complications. All vessels had TIMI III flow on completion.
Transcatheter coronary artery bypass with VECTOR is feasible in swine and may offer an effective solution to circumvent iatrogenic coronary artery obstruction following transcatheter aortic valve replacement when other transcatheter techniques are not possible.
冠状动脉阻塞是经导管主动脉瓣置换术一种罕见但具有毁灭性的并发症。目前的技术（经导管瓣叶改良或通气管支架置入）并不能在所有情况下预防阻塞。
我们创建了一种经导管冠状动脉旁路手术，即VECTOR（心室-冠状动脉经导管向外导航与再入路），用带覆膜支架移植物绕过冠状动脉近端。我们在猪身上测试了在距天然开口头端10至15毫米处创建新开口并绕过冠状动脉近端的可行性。我们使用经导管电外科手术建立近端吻合口，使其从主动脉穿出至心包。使用导丝建立远端吻合口，使其从冠状动脉近端穿出并进入心包。连接这些点，然后植入带覆膜支架移植物以绕过近端血管。使用冠状动脉造影和血管内超声评估移植物的通畅性和扩张情况。
VECTOR技术在11只猪身上研发成功，并在另外6只健康猪的右冠状动脉上实施。成功创建了近端和远端吻合口，最多输送3个（总长度40[35 - 45]毫米）带覆膜支架移植物以绕过近端血管。无显著并发症。所有血管在完成手术后均有TIMI III级血流。
VECTOR经导管冠状动脉旁路手术在猪身上是可行的，并且当其他经导管技术不可行时，可能为规避经导管主动脉瓣置换术后医源性冠状动脉阻塞提供一种有效的解决方案。
