利用Crusade導管在雙套左前降支冠狀動脈先天異常的介入性治療—一病例報告

A Case Report of Dual Left Anterior Descending Coronary Artery Anomaly with Crusade Catheter Intervention

雙套左前降支冠狀動脈（dual LAD）是一種罕見的先天性異常。我們描述一位患者主訴胸悶，後來使用螺旋電腦斷層攝影術（MDCT）發現有此冠狀動脈先天異常。經由撓動脈成功完成左前降支冠狀動脈（LAD）及其對角支 (DB) 嚴重分叉病灶的冠狀動脈介入術 (PCI) 。只要經過事前審慎評估血管的起源、路徑異常，使用特殊的血管導線操作是可以安全地和成功地穿越病灶。電腦斷層冠狀動脈血管造影術在事前評估血管的起源、路徑異常極為有用。我們在這篇文章詳細描述這種技術，結合Crusade 導管及逆行的導絲技術，我們預料這項技術將會提高血管導線進入嚴重分叉病灶的可能性及實用性。

Dual left anterior descending coronary artery (LAD) is a rare congenital anomaly. We report a patient presenting with chest tightness, who was subsequently found to have this coronary anomaly via Multidetector computed tomography (MDCT). He underwent staged percutaneous coronary interventions (PCI) of the totally occluded long LAD and its diagonal branch (DB) successfully through the radial route. We conclude that anomalous coronary artery disease can be safely and successfully treated through the radial route after careful evaluation of origin and course of the anomalous vessels. CT coronary angiography is extremely useful in delineating the vessel course and particularly their relation to great arteries. Then, we present a technique that combines the reversed guidewire technique with a Crusade catheter, and we expect that this technique will increase the rate of access into the intended vessels, particularly with a difficult anatomy. We describe the details of this technique, its usefulness, why it works, and when to employ it in clinical practice through the following case report.