Extended use of the Guide Liner in complex coronary interventions
Extended use of the Guide Liner in complex coronary interventions
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DOI：
10.4244/eijy14m06_02
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发表时间：
2015-07-01
期刊：
影响因子：
6.2
通讯作者：
Di Mario, Carlo
中科院分区：
文献类型：
--
作者：
Chan, Pak Hei;Alegria-Barrero, Eduardo;Di Mario, Carlo
目的：具有挑战性的冠状动脉解剖结构，包括慢性完全闭塞(CTO)、极端血管扭曲、病变的搭桥术和异常的冠状动脉，给冠状动脉介入治疗带来了困难。Guideliner是一种单轨导管，最初开发的目的是帮助将支架输送到曲折血管中的靶向病变。我们进行了一项关于在更广泛的复杂冠状动脉介入治疗中使用该导管的可行性和安全性的研究。方法和结果：连续接受冠状动脉或外周介入治疗的患者使用Guideliner进入本研究。前瞻性地将患者的人口统计学、病变和血管特征、操作细节和结果输入我们的数据库并进行分析。从2009年9月到2011年10月，连续54名患者在我们机构接受了冠状动脉介入治疗；54例冠脉应用中有21例是出于增加对交叉CTO的支持的需要，主要是RCA。治疗血管异常或成角度的起跳(31%)、以前放置的近端支架(15%)、近端严重钙化(9%)和弯曲(7%)是其余原因。1例患者在Guideliner导管的帮助下成功地切断了肾神经。本组手术成功率为98%，无与器械相关的围手术期并发症，如口部夹层或心肌坏死。结论：Guideliner的使用为复杂的冠状动脉介入治疗提供了更大的后备支持和更容易接触的冠状动脉开口，从而促进了复杂冠状动脉介入治疗的进行，包括慢性完全闭塞和大隐静脉移植介入。
Aims: Challenging coronary anatomies including chronic total occlusions (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries pose difficulties in coronary interventions. The GuideLiner is a monorail catheter originally developed to facilitate delivery of stents to target lesions in tortuous vessels. We conducted a study on the feasibility and safety of utilising this catheter in a wider array of complex coronary interventions.Methods and results: Consecutive patients undergoing coronary or peripheral interventions where a GuideLiner was used were recruited into this study. Patient demographics, lesion and vessel characteristics, procedural details and outcomes were prospectively entered into our database and analysed. From September 2009 to October 2011, 54 consecutive patients underwent coronary intervention in our institution using a GuideLiner; 21 out of 54 coronary applications were motivated by the need to increase support to cross CTOs, predominantly of the RCA. Anomalous or angulated take-off of the treatment vessels (31%), previously deployed proximal stents (15%), heavy proximal calcification (9%) and tortuosity (7%) accounted for the remaining reasons. One patient had successful renal denervation with the aid of a GuideLiner catheter. Procedural success was 98% in our series with no device-related periprocedural complications such as ostial dissection or myocardial necrosis.Conclusions: The use of a GuideLiner facilitates the approach to complex coronary interventions including chronic total occlusion and saphenous vein graft intervention by providing greater back-up support and easier engagement of coronary ostia.