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目的:分析深置指引导管技术在冠状动脉介入中的适用性和安全性。方法:在203例冠状动脉介入中采用了深置指引导管技术。涉及血管209支,包括左前降支(LAD)、左旋支(LCX)、右冠状动脉(RCA)。处理病变214处,其中C型病变占74.7%。所有病例的介入血管径路为股动脉。除4例为撤出释放了支架的球囊,余为球囊或支架难以通过病变而采用该技术。5例左主干、2例RCA开口有轻度狭窄。结果:采用深置指引导管技术进行介入的214处病变,成功处理204处,成功率95.3%。在操作成功的病例中,3例是经RCA近端已释放的支架深置指引导管,1例是经左主干支架向前降支深置指引导管,4例均成功撤出释放了支架的球囊;3例用1.5mm小球囊扩张靶病变后再深置指引导管完成后续的介入操作。1例发生左主干及LAD夹层。失败10例,其在深置指引导管下球囊或支架未能通过病变。结论:深置指引导管可有效地提高针对复杂、困难冠状动脉病变介入操作的成功率。在RCA进行该操作比较安全;但该术也可能会造成左主干及其分支内膜撕裂、夹层形成的严重并发症。
Objective: To analyze the applicability and safety of deep catheterization in coronary intervention. METHODS: Depth-guided catheterization was used in 203 patients undergoing coronary intervention. Involved in blood vessels 209, including the left anterior descending artery (LAD), left circumflex (LCX), right coronary artery (RCA). Treatment of 214 lesions, of which C-type lesions accounted for 74.7%. All cases involved in the vascular path for the femoral artery. In addition to the four cases for the withdrawal of the stent to release the balloon, the remaining balloon or stent difficult to adopt the technology of lesions. 5 cases of left main trunk, 2 cases of RCA opening mild stenosis. Results: Of the 214 lesions involved with deep guide catheter technique, 204 were successfully treated with a success rate of 95.3%. Among the successful cases, 3 were deep stent-guided catheters that had been released through the proximal end of the RCA, and 1 were left-deep stent-guided catheters through the left main stent. Four of them successfully removed the stent-free ball 3 cases with 1.5mm small balloon expand target lesions and then deep catheterization to complete the follow-up intervention. One case developed a left main trunk and LAD dissection. Failure in 10 cases, which under the guidance catheter deep catheter failed to pass the balloon or stent. Conclusion: Deep guiding catheter can effectively improve the success rate of interventional operation for complicated and difficult coronary artery disease. It is safer to perform this procedure at RCA; however, this procedure may also cause serious complications of tearing and dissection of the left main trunk and its branches.