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ȣ - 500432 33 |
Clinical feasibility of IVUS-guided wiring technique for stumpless chronic total occlusion of coronary arteries at side branch |
경북대학교 병원 순환기 내과 |
박용휘, 이동엽, 장귀련, 이현상, 양동헌, 박헌식, 조용근, 채성철, 전재은, 박의현 |
Background: Success rates for chronic total occlusion (CTO) have notably improved. But, they showed still insufficient success rates for unfavorable anatomical lesions such as stumpless and totally occlusive lesions or occlusion at side branch. We evaluated the clinical feasibility of IVUS-guided wiring technique for these unfavorable lesions.
Methods: we enrolled 13 patients with stumpless CTO lesions that were occluded at side branch. We put two guide-wires into main vessel and side branch at each. And then, we placed the IVUS catheter in the side branch and identified the entry points of the main vessel. And then, we pulled IVUS catheter back out of the guiding catheter. We penetrated the CTO lesions with OTW-support.
Results: 7 Fr guiding catheters were used in all of the cases. All patients underwent successful reopening of CTO lesions. TIMI 3 flow was achieved in all of the cases. Angiographic results presented at the Table. We used Conquest® and Miracle® wires to penetrate the CTO lesions. No patients showed PCI-related complication.
Conclusion: IVUS-guided wiring technique is useful and safe for unfavorable CTO lesions such as stumpless lesions and occlusion at side branch.
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Table. Clinical and angiographic results
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N=13 |
Age (years)
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58.9±8.1 |
Male |
8
(62%) |
Target coronary
arteries |
LAD/
RCA |
10
(77%)/ 3 (23%) |
Bridging
collaterals |
4
(31%) |
Collateral grades (Rentrop
grade) |
2.0±0.6 |
Lesion length
(mm) |
19.2±6.7 |
Angiographic
results |
Drug eluting
stent |
12
(92%) |
Balloon
angioplasty |
1
(8%) |
Reference vessel
diameter (mm) |
2.8±0.4 |
Mean stent length
(mm) |
32.2±10.7 |
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