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

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1 Original Articles Korean Circulation J 2000;308: 경요골동맥중재술에서심좌법의유용성에관한연구 최해종 김무현 양창호 차광수 김혜진김성근 이수훈 김상곤 김영대 김종성 Usefulness of Deep Seating Technique for Transradial Coronary Intervention Hae Jong Choi, MD, Moo Hyun Kim, MD, Chang Ho Yang, MD, Kwang Soo Cha, MD, Hye Jin Kim, RN, Seong Geun Kim, MD, Su Hun Lee, MD, Sang Gon Kim, MD, Young Dae Kim, MD and Jong Seong Kim, MD Department of Internal Medicine, College of Medicine, Dong-A University, Pusan, Korea ABSTRACT Background and ObjectivesSmaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. MethodsThirthy-five patients 23 males were included in this study since March 1998 to August Clinical presentation of these patients were stable angina 7 patients, unstable angina 17 patients, acute myocardial infarction 11 cases. The mean age was 688 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. ResultTwenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases 94%. Guiding catheters were used mostly with 6 Fr 30/35. In the left coronary system, usual Judkins left type was used in most of the patients 24/26, 92%, and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. ConclusionDeep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases. Korean Circulation J 2000; 308: KEY WORDSDeep seating technique Transradial coronary intervention Backup support. 서 론 921

2 922 대상및방법 대상환자의임상양상 Table 1. Baseline clinical characteristics Male/Female persons 23/12 Mean age years old 688 Clinical diagnosis Acute myocardial Infarction 11 Unstable angina 17 Stable angina 7 Vessel diseased 1/2/3 16/15/4 Vessel treated LAD/LCx/RCA 22/2/11 ACC/AHA lesion type A/B1/B2/C 1/8/12/14 AbbreviationLADLeft anterior descending coronary artery, LCxLeft circumflex coronary artery RCARight coronary artery 심좌법의정의 적응기준과제외기준 요골동맥중재술및심좌법 Korean Circulation J 2000;308:

시술시 사용한 유도도관은 30예에서 6 Fr를 교적 비고정적이고 도관의 1차 각도(primary curve) 사용하였고 5예에서는 7 Fr를 사용하였는데 그 중 4예 가 혈관에 손상을 줄 가능성이 적은 Judkins형이나 다 에서는 고속회전 죽상반 제거술을 시행한

Selection of guiding catheter Left coronary artery 결 과 유도도관의 선택 유도도관의 선택에서 좌관상동맥의 경우 Judkins Left 형 18예, Judikins Left형 4예, Kimny형 2예이었다.

0 4 Kimny 2 Right coronary artery Amplatz left 3 Amplatz right 3 Judikins right Multipurpose Abbreviations same as table 1

3 로 나눌 수 있다. 유도도관의 선택은 비교적 도관 끝부 대상환자의 시술소견 분이 부드러운 종류(Cordis사의 britetip이나 Schnei- 혈관의 병변형태는 B2/C가 26예(74%)로 3/4을 차 der사의 pinkpower 등)를 선택하고 도관의 각도가 비 지하였다. 시술시 사용한 유도도관은 30예에서 6 Fr를 교적 비고정적이고 도관의 1차 각도(primary curve) 사용하였고 5예에서는 7 Fr를 사용하였는데 그 중 4예 가 혈관에 손상을 줄 가능성이 적은 Judkins형이나 다 에서는 고속회전 죽상반 제거술을 시행한 후였다. 총 환 목적용 도관(multipurpose catheter)를 주로 사용하였 자 중 스텐트 시술이 26명, 풍선시술이 3명이었고 고속 다(Fig. 1). Table 2. Selection of guiding catheter Left coronary artery 결 과 유도도관의 선택 유도도관의 선택에서 좌관상동맥의 경우 Judkins Left 형 18예, Judikins Left형 4예, Kimny형 2예이었다. 우 관상동맥의 경우 Amplatz Left형 3예, Amplatz Right 형 3예, Judkins Right형 3예, multipurpose형 2예이 었다(Table 2). Judikins left Judikins left Kimny 2 Right coronary artery Amplatz left 3 Amplatz right 3 Judikins right Multipurpose Abbreviations same as table Fig. 1. Example of deep seating technique in 70 year-old man with previously failed PTCA. A Tortuous right coronary artery (RCA, small arrows) and critically narrowed distal RCA (large black arrow). B Deeply seated 6 Fr multipurpose catheter (arrow). C NIR mm stent was implanted without difficulty. D After chubby mm balloon inflation, good angiographic result was obtained. 923

Types of intervention PTCA/ Stent/ Rotalator 3/26/6 Reason for deep seating technique Failure to deliver balloon catheter 10

Complication 1/35 2% A B C D Fig. 2. Complicated case in 63 year-old male.

4 합병증 근위부혈관에대한장단기효과 Table 3. Procedural results Number of procedures 35 Radial approach Right/Left approach 34/1 Size of guiding catheter 6/7 Fr 30/5 Types of intervention PTCA/ Stent/ Rotalator 3/26/6 Reason for deep seating technique Failure to deliver balloon catheter 10 Difficulty or expected difficulty in 23 stent delivery Poor backuped guiding catheter 2 Procedural success 33/35 94% Complication 1/35 2% A B C D Fig. 2. Complicated case in 63 year-old male. A95% stenosis of the distal right coronary artery arrow. BDeep seating with AL2 catheter arrow. CBalloon inflation. DBradycardia and hypotension were developed just after stent insertion, which were disappeared after the guiding catheter removal. 924 Korean Circulation J 2000;308:

5 고안 요약 연구배경 : 925

6 방법 : 결과 : 결론 : 중심단어 REFERENCES 1) Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn 1989;16A: ) Kiemeneij F, Laarman GJ. Transradial artery Palmaz- Schatz coronary stent implantation: Result of single-center feasibility study. Am heart J 1995;130: ) Feldman R, Glemser E, Kaiser J. Coronary angioplasty using 6 french guides. Cathet Cardiovasc Diagn 1991; 23: ) Urban P, Moles VP, Pande AK. Percutaneous coronary angioplasty through 6 french guides. J Invas Cardiol 1992; 4: ) Peels HJ, Vanboven AJ, Den Heijer P. Deep seating of six french guides for delivery of new Palmaz-Schatz stents. Cathet Cardiovasc Diagn 1996;38: ) Von Sohstein R, Rasim O, Marone G, McCormick DJ. Deep intubation of 6 french guiding catheter for transradial coronary interventions. J invas Cardiol 1998;10: ) Bartorelli AL, Lavarra F, Trabattoni D, Fabbiocchi F, et al: Successful stent delivery with deep seating of 6 French guiding catheters in difficult coronary anatomy. Cathet. Cardiovasc. Intervent. 1999;48: ) Kim MH, Cha KS, Kim JS: Transradial intervention in coronary artery disease: Comparison with transfemoral interventions. Kor Circ J 1998;28: ) Kim MH, Cha KS, Kim HJ, Kim SG, Park JW, Kim YD, et al: Initial experience of rotational atherectomy in coronary artery disease. Kor Circ J 1999;29: ) Feldman T: Tricks for overcoming difficult stent delivery. Cathet. Cardiovasc. Intervent. 1999;48: Korean Circulation J 2000;308:

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Microsoft Word - 순3-9.doc Original ORIGINAL Article ARTICLE Korean Circulation J 2005;35:253-257 ISSN 738-5520 c 2005, The Korean Society of Circulation Judkins Left 형단일도관을사용한경요골동맥관상동맥조영술의유용성 동아대학교의과대학순환기내과학교실, 동맥경화및중재시술연구소 2 박은희