正向导丝进入夹层—看我如何摆脱困境-CPSmd.PDF

正向导丝进入夹层 —看我如何摆脱困境 刘 斌 吉林大学白求恩第二医院 北京 导丝前向进入夹层或假腔的通常处理方法 Strategies and Techniques Antegrade Drilling Penetration Wire Retrograde escalaton CART Reverse CART ADR Crossboss Singray Antegrade Wiring Excellent Steerability Soft-tipped Poor Penetration polymer- jacketed Good Steerability Moderate stiff- tipped polymer- Moderate Penetration jacketed Heavy tipped Excellent Penetration non-polymer- Easier Perforation jacketed Retrograde Techniques Dissection Re-Entry Techniques Wire Escalation Reverse CART Antegrade Dissection Re-Entry(ADR) CTO crossing through the subintimal space, advancing across the occlusion, re-entering into the distal true lumen The Hybrid Algorithm 病例1：平行导丝技术 60 老年男性，严重的间断胸痛，无AMI病史。 6F XB3.5 Pilot 50 导丝走在夹层 选用另一根导丝 Miracle 3 ，前进后走在假腔 保持Miracle 3在原位， Pilot 50向前探索真腔 两根导丝交替参照前进，最后Miracle 3 走在真腔达到血管 远端 Final result 逆向造影可明确远端真腔，考虑更换硬导丝 反复造影谨慎前行 Final Result 导丝走入夹层，继续这个方向调整尝试？ 是否对角支近段