双腔微导管在逆向导丝技术中应用开通CTO一例课件

1、双腔微导管在逆向导丝技术中应用开通CTO一例男 49岁危险因素：高血压胸痛2天伴轻度气促就诊ECG：ST-T变化CK-MB 32 ng/mL，TNI 8.7 ng/mL病史WBC 6.9*109/L, N 66%, HGB 127 g/L, PLT 253*109/LGPT 54 IU/L, ALB 28 g/L, SCr 76 mol/L, K+ 4.2 mmol/LTG 1.2 mmol/L, TC 5.0 mmol/L，HDL-C 0.9 mmol/L，LDL-C 2.7 mmol/LCK-MB 32 ng/mL，TNI 8.7 ng/mLX-ray： NUCG： LVEDD 55 mm

2、， EF 50%辅助检查CAG was performed 2 days after administrationLM：末端40-50%狭窄LAD：pLAD 95%狭窄LCX：钝缘支 99%狭窄（细小）RCA：pRCA 100%闭塞，远段侧支来自LCXCABG was recommended but refused.PCI was performed 1 week later.CAGPCI strategyLAD可能为罪犯血管，患者既然不考虑搭桥，为缓解心肌缺血和使患者能较长时间配合整个介入治疗过程，首先考虑PCI for pLAD；钝缘支 99%狭窄，但该病变远段血管细小，可以不考虑介入治疗

3、；RCA长段闭塞，从左冠提供的侧支来看血管较粗大。应尽可能开通，首先选择对侧造影指导下正向导丝技术，必要时采用逆向导丝技术。PCI for LAD6 F EBU 3.75 + Runthrough + Ryujin 2.0*20 mmPCI for LADFirebird2 3.0*29 mmPCI for LADFirebird2 3.0*29 mmPCI for LADHiryu 3.0*15 mmPCI for LADPCI for LADPCI for RCAAntegrade wiring6 F AL 0.75Finecross 150 mm + Fielder XT-RParall

4、el wire technique with Gaia FirstBut fail to cross mRCASubintimal Tracking And ReenteryFinecross 150 + Gaia FirstFailedFinecross 150 mm + Pilot 150 FailedFinecross 150 + Gaia ThirdFalse lumenKissing wire Antegrade: Finecross 150 mm + Gaia ThirdRetrograde: Finecross 150 mm + Sion BlueKissing wireAnte

5、grade: Finecross 150 mm + Gaia ThirdRetrograde: Finecross 150 mm + SION BlueRetrograde wiring Finecross 150 mm + Fielder XT由于心脏收缩，微导管来回摆动，导丝极易滑进PDA因此常规微导管辅助支撑下逆向导丝无法实现SION Blue置于PDAKANEKA双腔微导管沿导丝送达后三岔处略向前推送该软丝至PDA末端产生一定张力，此时双腔微导管位置即相对固定沿双腔微导管另一腔道送入Pilot 150顺利扎过逆向纤维帽Retrograde wiring6 F EBU 3.75 GC +

6、 KANEKA + Pilot 150Recanalization6 F EBU 3.75 GC + KANEKA + Pilot 150ExternalizationKANEKA 通过外径过大且长度不够经正向GC送入Ryujin 2.0*15 mm球囊于GC内扩张固定Pilot 150导丝头端借助延长导丝退出双腔微导管，经逆向GC送入Finecross 150 微导管进入正向GC随后交换Fielder FC 300 mm导丝体外化AngioplastyRyujin 2.0*15 mmAfter angioplastyStent DeploymentFirebird2 2.75* 33 mm（

7、12 atm）Stent DeploymentFirebird2 2.75* 33 mm（12 atm）Stent DeploymentFirebird2 3.5*18 mm（12 atm）Hiryu 3.5*15 mmFinal ResultsFinal ResultsCTO algorithmCareful analysis of CAG/MSCTProximal CAP ambiguityPoor quality distal vesselAntegrade wire based approachParallel wiring +/- IVUS-guided wiringDissection-reentry (CrossBoss/Stingray)In-stent restenosis)Consider use of CrossBoss as Primary crossing strategyIVUS-guided entryInterventional collaterals presentRetrograde approachNoNoYesYesNoNoYesXT/XTRG