PDF(Pubmed)
Abstract：
UNASSIGNED: Antegrade dissection and reentry (ADR) is an effective technique for wire passage in chronic total occlusion (CTO), and in recent years, the effectiveness of intravascular ultrasound (IVUS)-guided tip detection (TD)-ADR has been reported. However, the expansion of the subintimal space serves as a significant obstacle to the success of ADR, posing a limitation to the procedure.
UNASSIGNED: We present the first case of using IVUS-guided TD-ADR with the subintimal transcatheter withdrawal (STRAW) technique. The patient was a 68-year-old Asian female with effort angina pectoris and a CTO in the middle section of the right coronary artery (RCA). Two previous attempts at percutaneous coronary intervention (PCI) for the RCA at another hospital were unsuccessful. During the third attempt PCI, the antegrade wire migrated into the subintimal space. To address this, we performed IVUS-guided TD-ADR using the Conquest Pro 12 Sharpened Tip (CP12ST; Asahi Intecc, Aichi, Japan) wire. However, due to the expansion of the subintimal space, we were unable to puncture the true lumen. To reduce the subintimal space, we employed the STRAW technique, which allowed successful puncture of the true lumen using the CP12ST wire. Finally, stenting was performed, resulting in satisfactory antegrade blood flow.
UNASSIGNED: Intravascular ultrasound-guided TD provides accurate guidance for puncturing in ADR procedures, but the expansion of the subintimal space remains a significant challenge. The STRAW technique offers a solution by reducing the subintimal space and enabling successful puncture of the true lumen during IVUS-guided TD-ADR.
UNASSIGNED: We present the first case of using IVUS-guided TD-ADR with the subintimal transcatheter withdrawal (STRAW) technique. The patient was a 68-year-old Asian female with effort angina pectoris and a CTO in the middle section of the right coronary artery (RCA). Two previous attempts at percutaneous coronary intervention (PCI) for the RCA at another hospital were unsuccessful. During the third attempt PCI, the antegrade wire migrated into the subintimal space. To address this, we performed IVUS-guided TD-ADR using the Conquest Pro 12 Sharpened Tip (CP12ST; Asahi Intecc, Aichi, Japan) wire. However, due to the expansion of the subintimal space, we were unable to puncture the true lumen. To reduce the subintimal space, we employed the STRAW technique, which allowed successful puncture of the true lumen using the CP12ST wire. Finally, stenting was performed, resulting in satisfactory antegrade blood flow.
UNASSIGNED: Intravascular ultrasound-guided TD provides accurate guidance for puncturing in ADR procedures, but the expansion of the subintimal space remains a significant challenge. The STRAW technique offers a solution by reducing the subintimal space and enabling successful puncture of the true lumen during IVUS-guided TD-ADR.
摘要：
■顺行解剖和折返术（ADR）是一种用于慢性完全闭塞（CTO）中的线通过的有效技术，近年来,已经报道了血管内超声(IVUS)引导的尖端检测(TD)-ADR的有效性.然而,内膜下空间的扩大是ADR成功的重要障碍，对程序构成限制。
■我们介绍了使用IVUS引导的TD-ADR与内膜下经导管撤药（STRAW）技术的第一例。该患者是一名68岁的亚洲女性，患有劳力性心绞痛，右冠状动脉（RCA）中段有CTO。先前在另一家医院对RCA进行经皮冠状动脉介入治疗（PCI）的两次尝试均未成功。在第三次尝试PCI期间，顺行线迁移到内膜下空间。为了解决这个问题，我们使用ConquestPro12锐化尖端(CP12ST；AsahiIntecc，爱知,日本）电线。然而,由于内膜下空间的扩张，我们无法刺穿真腔.为了缩小内膜下空间，我们采用了STRAW技术，这允许使用CP12ST线成功穿刺真腔。最后,进行了支架置入术,导致令人满意的顺行血流。
■血管内超声引导的TD为ADR手术中的穿刺提供了准确的指导，但是内膜下空间的扩张仍然是一个重大挑战。STRAW技术通过减少内膜下空间并在IVUS引导的TD-ADR期间成功穿刺真腔提供了解决方案。
■我们介绍了使用IVUS引导的TD-ADR与内膜下经导管撤药（STRAW）技术的第一例。该患者是一名68岁的亚洲女性，患有劳力性心绞痛，右冠状动脉（RCA）中段有CTO。先前在另一家医院对RCA进行经皮冠状动脉介入治疗（PCI）的两次尝试均未成功。在第三次尝试PCI期间，顺行线迁移到内膜下空间。为了解决这个问题，我们使用ConquestPro12锐化尖端(CP12ST；AsahiIntecc，爱知,日本）电线。然而,由于内膜下空间的扩张，我们无法刺穿真腔.为了缩小内膜下空间，我们采用了STRAW技术，这允许使用CP12ST线成功穿刺真腔。最后,进行了支架置入术,导致令人满意的顺行血流。
■血管内超声引导的TD为ADR手术中的穿刺提供了准确的指导，但是内膜下空间的扩张仍然是一个重大挑战。STRAW技术通过减少内膜下空间并在IVUS引导的TD-ADR期间成功穿刺真腔提供了解决方案。
