On August 9, the team of Professor Cheng Xiang of the Department of Cardiovascular Medicine of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology published research results confirming that in vitro experiments confirmed that although most of the edge branch protection microcatheters and guide wires will have different degrees of damage, but no complete rupture occurs, indicating the relative safety of this technology, but there is still a certain risk in the two-finger guided tube microcatheter protection left trunk calcification spinning technology, the researchers only recommend that the use of this technology in patients with severe calcification of the left trunk bifurcation after strict screening.
The study was published in the Journal of Interventional Cardiology, titled "Safety Assessment of Double-Guided Catheter Rotational Arterectomy under Microcatheter Protection for Severe Calcification left trunk bifurcation", and was highly recommended on the front page of the journal's website (Figure 1).
The co-first authors of the article are Dr. Yang Shijun, Dr. Dong Silai, Dr. Zhou Yanzhao and Professor Wei Yumiao, and the corresponding author is Professor Cheng Xiang. (Figure 2)
Research interpretation
Clinically, surgical treatment of left trunk bifurcation lesions is difficult, because crest displacement or plaque displacement may cause acute occlusion of the anterior descending branch or cyclic branch, with catastrophic consequences. Coronary plaque rotation mill is a common method of interventional treatment of coronary calcification lesions, because it may cause the side branch guide wire to break, so the use of coronary rotation mill to treat bifurcated calcification lesions should not be placed to protect the side branches.
Therefore, the protection of collateral vascularity in the intervention of left trunk calcification bifurcation lesions has become a major problem. In 2019, some scholars published a Case report, trying to place microcatheters on the side branches for protection during the treatment of left trunk calcified bifurcation lesions, and then perform spin grinding of the main branch vessels, but the safety of this technology is still not clear.
In order to study the safety of two-finger guided tube microcater protection left trunk calcification spinning technology, Professor Cheng Xiang's team conducted in vitro experiments on this technology.
The researchers selected a coronary calcification vessel simulator (Figure 3) of three sizes ( Figure 3 ) with a diameter of 2.0 mm, 2.25 mm and a proximal lumen diameter of 2.0 mm, 2.25 mm and a pre-descending branch/gyrotron branch ( Fig. 3 ) ( Fig. 4 ) .
In vitro experiments have confirmed that although most side branch protection microcatheters and guide wires have different degrees of damage, none of them have complete fracture, suggesting the relative safety of this technique.
On this basis, Professor Cheng Xiang's team subsequently successfully applied this technique to clinical practice (Figure 5).
Given that most of the edge branch protection microcatheters or duct wires are damaged, there are still some risks in the two-finger guided tube microcatheter protection left trunk calcification spinning technique, and the researchers only recommend using this technique in patients with severe calcification of the left trunk bifurcation after rigorous screening.