在耐火性心室动中使用16F外的IMPELLA CP支持的单次访问穿皮冠状动脉干预:一个病例报告
Yuki Sunami1, Takumi Toya2,3, Takafumi Nishimura1
1Division of Cardiology, NHO Tokyo Medical Center, Tokyo, Japan.
概括
一种使用16 Fr/14 Fr/6 Fr的新型同轴股骨方法允许安全的单次访问Impella支持的皮肤冠状动脉干预 (PCI). 这一策略提高了程序的效率,并减少了当辐射接入是不可行的出血的风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 复杂的心脏骤停的病例通常需要联合静脉动脉外体膜氧化 (VA-ECMO),Impella左心室卸载和紧急皮肤冠状动脉干预 (PCI).
- 在这些高风险患者中,血管接入可能是一个重要的程序性挑战.
- 传统的单一访问Impella-PCI方法在工作流效率和出血风险之间存在权衡,特别是当辐射访问不是一个选择时.
研究的目的:
- 提出一个救援战略,以实现单一访问,在辐射访问无法实现的情况下,实现Impella支持的PCI.
- 描述一个同轴的配置,使复杂的干预措施,同时最大限度地减少出血并发症.
主要方法:
- 在左侧常见的股骨动脉中采用同轴的16 Fr/14 Fr/6 Fr护套配置.
- 一个16 Fr Medikit罩被放置,随后是同轴插入一个14 Fr剥离罩,用于Impella CP植入.
- 一个6 Fr通过Impella进行了推进,以实现穿皮冠状动脉干预 (PCI).
主要成果:
- 描述的同轴策略成功实现了单次访问Impella支持的PCI在患有耐火性心室动和冠状动脉封闭的患者中.
- 该程序涉及VA-ECMO通过右大腿管道和Impella CP植入通过同轴系统.
- 通过6 Fr外成功部署支架,除了16 Fr外的所有外在术后被移除,没有出血并发症.
结论:
- 一个同轴的16 Fr/14 Fr/6 Fr腿部方法提供了一个安全有效的方法,用于单次访问的Impella支持的PCI.
- 这种技术将程序效率与降低出血风险相结合,当辐射接入不可行时,特别有价值.
- 这种策略为复杂的心脏骤停干预提供了可行的解决方案,需要机械循环支持和再血管化.
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