McIvor M E, Rosenthal A D, Lawson J
Cardiology Consultants, All Children's Hospital, St. Petersburg, FL 33707.
Cathet Cardiovasc Diagn. 1993 Jul;29(3):251-6. doi: 10.1002/ccd.1810290316.
Directional coronary atherectomy (DCA) is an important advance in the mechanical revascularization of stenotic coronary arteries. The bulky nature of the DCA device has necessitated the use of guiding catheter designs that are more cumbersome to use than balloon angioplasty guiding catheters. Because engagement of coronary artery ostia with the currently available DCA guiding catheters is often difficult and because DCA guiding catheters significantly "relax" and reshape during the atherectomy procedure, angiography using these guiding catheters before and after atherectomy can be suboptimal. A new technique for angiography during atherectomy using long Judkin's diagnostic catheters inserted through the existing DCA guiding catheters is described. This technique can be used for optimal visualization of the coronary arteries with minimal use of contrast before and after sessions of atherectomy and also can be used to help engage the DCA guiding catheters. Some improvements in the design of guiding catheters for DCA are suggested.
定向冠状动脉斑块旋切术（DCA）是狭窄冠状动脉机械性血运重建的一项重要进展。DCA装置体积较大，这就需要使用比球囊血管成形术引导导管更笨重的引导导管设计。由于冠状动脉开口与目前可用的DCA引导导管的接合常常困难，且DCA引导导管在斑块旋切过程中会显著“松弛”并重塑形状，因此在斑块旋切前后使用这些引导导管进行血管造影可能效果欠佳。本文描述了一种在斑块旋切术中使用通过现有DCA引导导管插入的长Judkin诊断导管进行血管造影的新技术。该技术可用于在斑块旋切术前和术后以最少的造影剂用量实现冠状动脉的最佳可视化，还可用于帮助接合DCA引导导管。文中还提出了一些对DCA引导导管设计的改进建议。
