Annex B H, Sketch M H, Stack R S, Phillips H R
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Cardiol Clin. 1994 Nov;12(4):611-22.
The TEC is a forward-cutting atherectomy catheter that has the unique potential to excise and aspirate atheroma, especially intraluminal thrombus. This device has been under clinical investigation for more than 6 years and received final marketing approval by the FDA for the treatment of lesions in the coronary vasculature in 1993. In the US TEC Multicenter Registry, the overall clinical and lesion successes were favorable. The success rates were similar for both native coronary vessels and saphenous vein bypass grafts. Importantly, the procedural success rates were maintained even in the presence of several unfavorable angiographic features, such as ostial location, intraluminal thrombus, and total occlusion. Further insights into the mechanisms of action of the TEC were made from studies using percutaneous angioscopy and intravascular ultrasound. Angioscopy clearly demonstrated that the TEC was indeed able to remove intraluminal thrombus, especially loosely adherent red thrombus, in a population of patients with unstable coronary syndromes. However, the TEC frequently leaves behind multiple intimal disruptions which not only create a possible nidus for restenosis but also explain the frequent hazy angiographic appearance of the vessel after TEC atherectomy. As is true for all new interventional devices, the specific niche for the TEC in interventional cardiology will best be determined in randomized clinical trials. There are several areas in which the TEC appears promising. First, this device may have a role in the management of patients with diffusely diseased saphenous vein grafts. Second, the TEC may be an effective primary therapy in lesions with intraluminal thrombus. Treatment with the TEC may then be followed by an adjunctive therapy to maximize the final vessel diameters. Finally, the TEC may be valuable in the treatment of lesions in patients with high-risk unstable coronary syndromes.
TEC是一种前端切割旋切导管，具有切除和抽吸动脉粥样硬化斑块（尤其是管腔内血栓）的独特潜力。该设备已进行了6年多的临床研究，并于1993年获得美国食品药品监督管理局（FDA）的最终上市批准，用于治疗冠状动脉血管病变。在美国TEC多中心注册研究中，总体临床和病变治疗成功率令人满意。天然冠状动脉血管和大隐静脉旁路移植血管的成功率相似。重要的是，即使存在一些不利的血管造影特征，如开口位置、管腔内血栓和完全闭塞，手术成功率仍能维持。通过使用经皮血管镜检查和血管内超声的研究，对TEC的作用机制有了进一步的认识。血管镜检查清楚地表明，在不稳定型冠状动脉综合征患者群体中，TEC确实能够清除管腔内血栓，尤其是松散附着的红色血栓。然而，TEC经常会留下多处内膜损伤，这不仅可能形成再狭窄的病灶，还解释了TEC旋切术后血管造影中血管频繁出现模糊外观的原因。与所有新的介入设备一样，TEC在介入心脏病学中的特定应用领域最好通过随机临床试验来确定。TEC在几个方面看起来很有前景。首先，该设备可能在弥漫性病变的大隐静脉旁路移植血管患者的治疗中发挥作用。其次，TEC可能是治疗管腔内血栓病变的一种有效的一线治疗方法。然后，用TEC治疗后可接着进行辅助治疗，以最大限度地扩大最终血管直径。最后，TEC在治疗高危不稳定型冠状动脉综合征患者的病变中可能很有价值。
