서 론 관찰대상및방법 Fig. 1. Construction of the Crosswire TM distal tip. Table 1. Clinical characteristics and lesion characteristics Characteristics Age year

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1 Original Articles Korean Circulation J 1999;2910: 새로운유도철선인 Crosswire TM 를이용한관상동맥 완전폐쇄병변에대한치료경험 김남호 정명호 김인수 이승욱 김건형 김준우김성희 조장현 안영근 조정관 박종춘 강정채 Coronary Angioplasty for the Total Occlusion Using a New Hydrophilic Guidewire, Crosswire TM Nam Ho Kim, MD, Myung Ho Jeong, MD, In Soo Kim, MS, Seung Uk Lee, MD, Kun Hyung Kim, MD, Joon Woo Kim, MD, Sung Hee Kim, MD, Jang Hyun Cho, MD, Young Keun Ahn, MD, Jeong Gwan Cho, MD, Jong Chun Park, MD and Jung Chaee Kang, MD The Heart Center, Chonnam University Hospital, The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea ABSTRACT Background and ObjectivesCoronary angioplasty of total occlusion is associated with low primary success rate. The most common reason for failure is the inability to cross the lesion with a guidewire. The new nitinol wire consists of an extraordinary flexible nitinol core, a platinum/iridium coil at the distal tip, and a polymer hydrophilic coating providing the wire with an extremely slippery surface after moistening. Methods and MaterialsWe analyzed the angiographic results in 117 patients 86 M, 31 F, year, who underwent angioplasty for total occlusion with Crosswire TM at Chonnam University Hospital between Oct 97 and Apr 99. Clinical diagnosis was acute myocardial infarction MI in 61, old MI in 16, unstable angina in 23, and stable angina in 17 patients. ResultsTarget coronary arteries were 51 left anterior descending arteries LAD, 13 left circumflex arteries LCX and 53 right coronary arteries RCA. Lesion morphology was 40 abrupt and 77 tapered lesions, and collateral circulation was observed in 75 cases. The success rate was 80.3% 94/117. The reasons of procedural failure were failure to cross the lesion using wire in 8 and balloon in 6 cases. In the failed cases, clinical diagnosis was acute MI in 10, unstable angina in 8 and stable angina in 5, and target artery was 11 LAD, 2 LCX and 10 RCA, and collateral circulation was observed in 20. In 56 cases of chronic total occlusion, the success rate was 76.8% 43/56 and the reasons of procedural failure were failure to cross the lesion using wire in 6 and balloon in 2 cases. No major cardiac events were developed. There was no predictive factor for the procedural failure with Crosswire TM for total occlusion. ConclusionsA new nitinol wire, Crosswire TM was an effective tool for the recanalization of total occlusive coronary artery. Korean Circulation J 1999;2910: KEY WORDSCoronary artery disease Total occlusion Guide wire. 1070

2 서 론 관찰대상및방법 Fig. 1. Construction of the Crosswire TM distal tip. Table 1. Clinical characteristics and lesion characteristics Characteristics Age years No. % Sex M:F Clinical diagnosis Acute myocardial infarction Old myocardial infarction Unstable angina pectoris Stable angina pectoris Target vessel Left anterior descending artery Left circumflex artery Right coronary artery Lesion morphology Abrupt lesion Tapered lesion Values are expressed as meansd or number percentage. Table 2. Success rate and procedural failure Success rate No. % Procedural failure Failure of guide wire passage Failure of balloon catheter passage Dissection Thrombus formation Chronic total occlusion 56 Success rate Procedural failure Failure of guide wire passage Failure of balloon catheter passage Dissection Thrombus formation

3 결과 Table 3. Comparison of clinical, angiographic and procedural characteristic in success and failure groups Clinical diagnosis Success Group n94 Failure Group n23 p value AMI UAP SAP Angiographic features LAD LCX RCA Length of occlusion mm Collateral circulation Grade Grade Grade Grade Intraarterial Interarterial Attempts of Crosswire First choice Second choice Procedural factors Abrut lesion Tapered lesion Values are expressed as number percentage. AMIacute myocardial infarction, UAPunstable angina pectoris, SAPstable angina pectoris, LADleft anterior descending artery, LCXleft circumflex artery, RCA right coronary artery 1072 Korean Circulation J 1999;2910:

4 Table 4. Comparison of clinical, angiographic and procedural characteristic in success and failure groups in chronic total occlusion Clinical diagnosis Success Group n43 Failure Group n13 p value OMI UAP SAP Angiographic features LAD LCX RCA Length of occlusion mm Collateral circulation Grade Grade Grade Grade Intraarterial Interarterial Attempts of Crosswire First choice Second choice Procedural factors Abrut lesion Tapered lesion Values are expressed as number percentage. AMIacute myocardial infarction, UAPunstable angina pectoris, SAPstable angina pectoris, LADleft anterior descending artery, LCXleft circumflex artery, RCAright coronary artery 고찰 1073

연구의 한계점 본 연구는 소수의 환자를 대상으로 시행되었고, 일반 적인 유도 철선이 병변을 통과하지 못한 경우뿐만 아니 라 완전 폐쇄 병변인 경우 처음부터 Crosswire TM을 사용한 경우도 있어, 일반적인 유도 철선에 의해 병변 통과가 실패한 경우에 비해 더 나은 성공률을 보였다는 점을 객관적으로 증명하지는 못하였다.

5 pushability와 매끄러움으로 인해 천공이나 내막 박리 의 위험성이 높아 부드러운 조작과 시술자의 풍부한 경 험이 필요하다고 생각되었다. 본 연구의 결과에서 CrosswireTM을 사용하여 PTCA를 한 경우 완전 폐쇄 병변에서의 PTCA 성공률이 80.3%로 다른 보고자에 비해 비교적 높은 성공률을 보였으며, 본 연구의 대상 환자중 급성 심근 경색증을 제 외한 56 예의 만성 완전 폐쇄 병변에 대해서도 43예에 서 성공하여 비교적 효과적인 치료 시술 기구의 하나로 이용될 수 있을 것으로 생각되었다(Fig. 2). 연구의 한계점 본 연구는 소수의 환자를 대상으로 시행되었고, 일반 적인 유도 철선이 병변을 통과하지 못한 경우뿐만 아니 라 완전 폐쇄 병변인 경우 처음부터 Crosswire TM을 사용한 경우도 있어, 일반적인 유도 철선에 의해 병변 통과가 실패한 경우에 비해 더 나은 성공률을 보였다는 점을 객관적으로 증명하지는 못하였다. 하지만, 본 연구 의 결과만으로도 일반적인 유도 철선이 병변을 통과하 지 못한 경우나 매우 심한 굴곡이 있는 혈관 등에서는 처음부터 시도해 볼 수 있는 시술 기구라 생각되었다. Fig. 2. A Successful angioplasty was performed using Cross-wire for the long segmental chronic total occlusion of left anterior descending artery (LAD) under the guidance of contralateral right coronary angiogram. B No significant residual stenosis and good distal LAD flow were obtained. 요 약 연구배경 관상동맥 중재술을 이용한 관상동맥 질환의 치료의 지고 있어 shaft의 고도의 탄력성과 안정성을 주어서 성적은 향상되고 있으나, 완전 폐쇄 병변의 경우 그 치료 적절한 pushability와 굴곡성을 제공하고, 말단부 끝에 성공률은 낮다. 저자들은 완전 폐쇄 병변의 치료에 새로 는 platinum/iridium coiled tip을 가지고 있어 형태 지 개발된 유도 철선을 도입하여 시술 성적을 비교하였다. 속성과 방사성 밀도(radiodensity)를 높였고, polymer 대상 및 방법 hydrophilic coating이 되어 있어서 물이나 혈액에 적 관찰대상은 1997년 10월부터 1999년 4월까지 전남 셔지면 매우 미끄러운 표면을 형성하게 되어 혈관과 유 대학교병원 순환기내과에서 Crosswire TM를 이용하 도 도자에서 마찰을 감소시키며 색전 형성을 감소시킴 여 중재 시술을 시행하였던 환자 중 완전 폐쇄 병변으로 19-22) 으로써, 완전 폐쇄 병변의 통과가 용이하도록 해 서 중재 시술을 시행한 117예를 대상으로 하였다. 대상 주고 있다. 그러나, polymer hydrophilic coating에 의 환자는 남자가 86예 여자가 31예였고, 평균 연령은 58.5 해 매우 미끄럽기 때문에 시술시 유도철선을 다루는데 ±11.7세이었다. 어려움이 있어 plastic torque의 사용이 필요하며, 병변 결 과 부위에서 마찰력이 적어 풍선 도자의 교체나 스텐트를 1) 임상 진단은 급성 심근경색증 61예, 진구성 심근 시술 할 때 유도철선이 병변 부위에서 쉽게 빠지는 경 경색증 16예, 불안정형 협심증 23예, 안정형 협심증 17 우가 있어서 주의를 요하기도 하였다. 또한, marked 예이었다 Korean Circulation J 1999;29(10):

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Original Articles Korean Circulation J 2000;30 8 : 경요골동맥중재술에서심좌법의유용성에관한연구 최해종 김무현 양창호 차광수 김혜진김성근 이수훈 김상곤 김영대 김종성 Usefulness of Deep Seating Tec

Original Articles Korean Circulation J 2000;308:921-926 경요골동맥중재술에서심좌법의유용성에관한연구 최해종 김무현 양창호 차광수 김혜진김성근 이수훈 김상곤 김영대 김종성 Usefulness of Deep Seating Technique for Transradial Coronary Intervention Hae Jong