Retrograde coronary intervention for chronic total occlusion of RCA ostium with anomalous origin: A case report.
Retrograde coronary intervention for chronic total occlusion of RCA ostium with anomalous origin: A case report.
复制标题
逆行冠状动脉介入治疗异常起源的 RCA 口慢性完全闭塞：病例报告。
DOI：
10.1016/j.jccase.2019.01.003
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发表时间：
2019
影响因子：
--
通讯作者：
Uemura Shiro
中科院分区：
文献类型：
--
作者：
Yamada Ryotaro;Hirihata Atsushi;Kume Teruyoshi;Neishi Yoji;Uemura Shiro
慢性冠状动脉完全闭塞（CTO）仍然是进行介入治疗的最具技术挑战性的临床场景之一。尽管顺行入路是CTO再通的一般方法，但逆行尝试可提高成功率，近年来其使用越来越多。先天性冠状动脉异常是另一个技术上具有挑战性的因素，特别是当伴有CTO病变时。我们报告的情况下，43岁的男子没有相关的心脏病史谁提出的评价劳力性胸部不适与心悸。冠状动脉造影显示，CTO仅位于右冠状动脉（RCA）的开口处，主动脉窦内无血管造影开口凹陷。由于无法在RCA入口处与顺行导引导管（GC）接合，我们决定采用逆行入路进行血运重建。经皮冠状动脉介入治疗（PCI）这种异常的RCA，这是长期闭塞，是困难的，很少被描述。逆行入路已被用于克服不可能将顺行GC放置到RCA口的困难。CTO-PCI成功后，患者胸部不适立即消失。学习目的：经皮冠状动脉介入治疗右冠状动脉起源异常（RCA）患者的慢性完全冠状动脉闭塞是困难的，很少被描述。逆行入路已被用于克服不可能将顺行导引导管放置到RCA口的困难。>
Chronic total coronary occlusion (CTO) remains one of the most technically challenging clinical scenarios in which to perform interventions. Although the antegrade approach is a general approach for CTO recanalization, a retrograde attempt improves the success rate and its usage has been increasingly adopted in recent years. Congenital coronary anomaly represents another technically challenging factor especially when accompanied with CTO lesions. We report the case of a 43-year-old man with no relevant cardiac history who presented for evaluation of exertional chest discomfort with palpitation. Coronary angiography revealed the existence of CTOs at just ostial of anomalously originating right coronary artery (RCA) with no angiographic ostial dimple in Valsalva sinus. Because it was not possible to engage with the antegrade guiding catheter (GC) at the inlet of the RCA, we decided to perform revascularization using the retrograde approach. Percutaneous coronary intervention (PCI) of such an anomalous RCA, which is chronically occluded, is difficult and is rarely described. Retrograde approach has been used to overcome the impossible placement of antegrade GC to RCA ostium. After successful CTO-PCI, his chest discomfort promptly disappeared.<Learning objective:Percutaneous coronary intervention for chronic total coronary occlusion of anomalous origin of right coronary artery (RCA) patients is difficult and is rarely described. Retrograde approach has been used to overcome the impossible placement of antegrade guiding catheter to RCA ostium.>