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1、CTO介入治疗：逆向导丝通过后顺向轨道建立方法张奇上海交通大学医学院附属瑞金医院CaseinformationMale,75yUAPCHF(NYHAII)HypertensionCOPDLVEF0.43Pervious-PCI:2010-8CAGPCI前向失败前向失败→逆向MC+M3MC+Pilot150CTO-PCI：逆向治疗回顾逆向钢丝通过血管闭塞段后如何建立顺向轨道？正向进入导引钢丝(Kissingwire)逆向球囊扩张闭塞段后正向进入钢丝(Retrogradeinflation)逆向钢丝直接进入正向指引导管后推出(Externalization)
2、双微导管对接技术(RendezvousMethod)正向钢丝对接逆向微导管（modifiedRendezvous）正向进入微导管到闭塞段近段血管，逆向钢丝在冠脉内进入正向微导管后跟进正向微导管,使其通过闭塞段血管，正向进入钢丝正向进入指引导丝KissingWire在正向指引导管内进入正向钢丝，沿逆向钢丝路径到达闭塞段远段血管腔逆向钢丝作用：路标&在闭塞段内创建缝隙，有利于正向钢丝进入http://www.rjh.com.cnCaseInformationMale,58yClinicalPresentation:StableAnginaPectoris,R
3、iskFactors:Hypertension,HypercholesterolemiaRestingECK:ST-TchangesLVEFby2-DEcho:0.55CAGPCIMC+M3RunthroughPCIStentingandResults逆向球囊扩张后正向进入钢丝RetrogradeInflation沿逆向钢丝进入球囊到闭塞段进行预扩张逆向微导管不能通过病变时侧枝血管要求较高（内经大、行径直）正向指引导管内球囊锚定(2.5mm)逆向钢丝，有助于逆向球囊通过应用小球囊(1.2-1.25mm)正向指引导管内球囊锚定钢丝逆向进入球囊扩张2.5x1
4、5mmballoonanchorinAnteG.C.1.25x15mmballoonretrogradeinflation正向钢丝进入RunthroughwireplacedinLADAfterstenting逆向钢丝推出正向指引导管Externalization圈套（抓捕）器(snare)应用，将逆向钢丝抓入正向指引导管（若应用的为300cm钢丝，可直接拉出正向指引导管）若应用普通长度钢丝，须将钢丝进入正向指引导管内，推送微导管后交换为300cm长度钢丝（不推荐使用延长钢丝或旋磨钢丝）若推送微导管有阻力，可应用正向指引导管内球囊锚定，或逆向扩张Case
5、InformationMale,34yExertionalchestdiscomfortfor13monthsSmokingfor11y,(1/2pack/d)NoothercoronaryriskfactorsLVEF:0.58EKG:ST-TchangesinI,aVL,V4-6CAGPCIMC+M3MC+FieldFC(300cm)+SnarePCIAnte-wireplacement,runthroughExternalizationof300cmwire,andpredilationPCIStentingandResultsCaseInform
6、ationMale,69yAggravatedchestpainin2weeksRiskfactors:hypertension,hypercholesterolemiaMedicalhistory:2010,STEMI(Inf.)andreceivedprimaryPCIforRCA.Sub-totaloccludedLADwasfoundduringprimaryPCI,butnottreated.LVEF0.61PCIforLADBilateralangiogram(R-Radial:6F90cmJR3.5Guidingcatheter;R-Fem
7、oral:6F100cmBL3.5guidingcatheter)150cmFinecrossMC+Field-XTAnte-gradePCI(60min)CollateralModification -Balloondilation1.2Mini-trekballoonFinecrossMCreachedthedistal...RetrogradePenetrationPilot-150wireAnte.-balloonanchoring,MCretro-crossing,wire(300cmField-FC)externalization,andpr
8、edilation(ante.)balloonanchoringandMCcro
