Whitlow P L
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
Cathet Cardiovasc Diagn. 1993;Suppl 1:72-5.
The size and rigid length of the directional coronary atherectomy catheter creates a new set of demands and constraints for guiding catheter manufacturers. Large lumen guides with gradual, rather than abrupt, curves are necessary, and a number of unique shapes have been developed to address native coronary and saphenous vein graft anatomy. The guiding catheter has a tendency to straighten and disengage from the coronary or graft ostium as the DCA device is advanced, and coaxial alignment of the body of the guiding catheter is essential to engage the atherectomy device. Power-positioning and deep seating of these large lumen, thin walled, and rather rigid guides should be avoided, to minimize ostial complications. These guiding catheters require modifications of usual techniques for introduction, manipulation and maintenance or coaxial alignment with the target vessel, as well as for withdrawal through the aortic bifurcation. Strategies for successful guiding catheter selection and utilization are outlined.
定向冠状动脉斑块旋切导管的尺寸和刚性长度对引导导管制造商提出了一系列新的要求和限制。需要大腔径、具有逐渐而非突然弯曲的引导导管，并且已经开发出多种独特形状以适应冠状动脉和大隐静脉桥血管的解剖结构。当推进旋切装置时，引导导管有伸直并从冠状动脉或移植血管开口处脱离的趋势，引导导管主体的同轴对准对于使斑块旋切装置发挥作用至关重要。应避免这些大腔径、薄壁且相当刚性的引导导管进行强力定位和深插入，以尽量减少开口处并发症。这些引导导管在插入、操作和维持与目标血管的同轴对准以及通过主动脉分叉撤出时，需要对常规技术进行改进。本文概述了成功选择和使用引导导管的策略。
