Hsia T Y, Billingham M, Sung R J
Falk Cardiovascular Research Center, Stanford University School of Medicine, California, USA.
J Interv Card Electrophysiol. 1997 Feb;1(1):7-14. doi: 10.1023/a:1009750215308.
To develop a new technique for ablating arrhythmias by interrupting coronary perfusion of the myocardium, we studied six mongrel dogs, weighing 20-35 kg. Under angiographic guidance a microcatheter (1.0 mm diameter) was introduced into a branch of the left anterior descending or posterior descending coronary artery. A detachable platinum coil (0.0254 cm diameter, 3 cm length) soldered onto a stainless-steel delivery wire (Guglielmi) was inserted through the microcatheter and advanced to occlude the arterial branch. A 0.5-mA electric current applied to the proximal end of the delivery wire resulted in intravascular thrombosis due to attraction of the negatively charged blood cells, platelets, and fibrinogen to the positively charged platinum coil. In approximately 4.5 minutes, as the thrombus was formed, electric current dissolved the soldering and detached the platinum coil from the delivery wire. Electrocardiograms showed focal ST-T changes but no ventricular tachyarrhythmias. Pathologic studies revealed thrombosis around the platinum coil and well-demarcated focal ischemia/infarction that was correlated with elevation of cardiac enzymes. We conclude that intracoronary arterial embolization and electrothrombosis using an electrolytic platinum coil can be selectively performed in a very small coronary arterial branch, resulting in a limited area of myocardial damage. This technique is potentially useful for ablating arrhythmias and may be safer and more controllable than intracoronary alcohol infusion.
为了开发一种通过中断心肌的冠状动脉灌注来消融心律失常的新技术，我们研究了6只体重20 - 35千克的杂种犬。在血管造影引导下，将一根微导管（直径1.0毫米）插入左前降支或后降支冠状动脉的一个分支。将一个焊接在不锈钢输送导丝（古列尔米）上的可拆卸铂线圈（直径0.0254厘米，长度3厘米）通过微导管插入并推进以阻塞动脉分支。向输送导丝近端施加0.5毫安电流，由于带负电荷的血细胞、血小板和纤维蛋白原被吸引到带正电荷的铂线圈上，导致血管内血栓形成。在大约4.5分钟内，随着血栓形成，电流溶解焊点并使铂线圈与输送导丝分离。心电图显示局灶性ST - T改变，但无室性快速心律失常。病理研究显示铂线圈周围有血栓形成以及界限清楚的局灶性缺血/梗死，这与心肌酶升高相关。我们得出结论，使用电解铂线圈进行冠状动脉内栓塞和电血栓形成可以在非常小的冠状动脉分支中选择性地进行，导致有限的心肌损伤区域。这项技术可能对消融心律失常有用，并且可能比冠状动脉内注入酒精更安全、更可控。
