Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3585_Библиотеки_им_академика_М_И_Перельмана
.pdf
KazuakiMitsudo
Non-Pushing PCI
Techniques
123
Non-Pushing PCI Techniques
KazuakiMitsudo
https://t.me/medicina_free
Non-Pushing PCI Techniques
KazuakiMitsudo
https://t.me/medicina_free
Department of Cardiology
Kurashiki Central Hospital
Kurashiki
Okayama
Japan
This English edition was published as a co-edition with its original Japanese language edition, Jutsusha
MITSUDO no osanai PCI, copyright © 2016 by Igaku-Shoin Ltd., Tokyo Japan
ISBN 978-981-15-7042-1
https://doi.org/10.1007/978-981-15-7043-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
ISBN 978-981-15-7043-8 (eBook)
These manuscripts of my late husband are being published as a result of the
https://t.me/medicina_free
efforts of many people.
My husband was deeply committed to PCI.He was constantly focused on
ways of spreading his technical knowledge and often spoke about writing new
manuscripts for this purpose. He dedicated each moment of his spare time for
writing this manuscript, even when it allowed for only a single additional
line. On the eve of the completion of these manuscripts, he suddenly passed
away due to illness, something for which I believe he would have shown
terrible disappointment.
Those who were left behind following his death suddenly had the mission of
transforming his manuscripts into a book that would fulll his wishes of
transmitting his wealth of ideas and techniques accumulated over many years
of professional experience to as many people as possible. Over the years, he
pushed his physiological limits in order to realize his potential from his
commencement as a trainee physician and continued to work in this fashion
right until his passing. In fact, the day before he was struck by sudden illness,
he was working late into the night in order to prepare these manuscripts. It
seemed to me that he would do whatever was possible in order to complete as
many manuscripts as possible, despite this potentially shortening his life. He
was unfortunately unable to nish all of his work, leaving some remaining
areas in which his intentions may not be well understood. Despite this, we
would be delighted if this book is widely read and signicantly contributes to
the development of PCI in the future.
I would like to deeply express my sincere appreciation to the many doctors
who supported my husband in this publication, including members of the
Department of Cardiovascular Medicine at Kurashiki Central Hospital. I am
especially grateful to Dr. Hiroyuki Tanaka, Dr. Seiji Habara, and medical
secretary Makiko Kanaike, who generously provided editorial support, case
reports, and gures/tables despite their busy daily clinical practice.
July 2016
Kazuyo Mitsudo
Foreword
https://t.me/medicina_free
Dr. Kazuaki Mitsudo passed away due to sudden illness on October 18, 2015, to the immeasurable grief of his family. He was constantly striving to improve the outcomes of PCI, and we
believe that he would have been incredibly disappointed at being deprived of the opportunity
to completely fulll this accomplishment.
Dr. Mitsudo had prepared a manuscript on PCI prior to his death, which was recently published as Mitsudo’s Non-Pushing PCI Techniques. He was involved in the development of
many devices of use in the PCI eld and invented many novel techniques. He also made a
signicant contribution to the development of PCI through live demonstrations and technical
training sessions. Among the many PCI elds, this book focuses on his techniques for chronic
total occlusion and bifurcation lesions, including left main trunk lesions, which he described
as the “nal frontier of PCI.” Based on his long experience, he also prepared a separate chapter
on non-pushing PCI, which is considered to be the key to successful PCI.
Dr. Mitsudo previously published another book, PTCA Technique (Igaku Shoin), in 1995.
The preface states that: “Technique is quite often based on experience. Indeed, there are techniques which are difcult to explain through words and photos. However, technique with a
sound rationale can be explained.” His PCI methods were not only based on excellent technique, but also on ample experience and clinical data, as well as a sound rationale. We have
learned much directly from Dr. Mitsudo and have received invaluable instruction from him.
This book explains the signicance and background of each PCI technique, as well as its clinical application, in a logical manner. It conveys the essence of PCI as practiced by Dr. Mitsudo
to all professionals in the eld of interventional medicine.
To realize the publication of this book, staff members from the Department of Cardiovascular
Medicine at Kurashiki Central Hospital have brushed up and summarized the manuscripts
written by Dr. Mitsudo while remembering his lessons about PCI.We have tried to reect his
words as accurately as possible, but we ask for your understanding where we have failed to
clearly portray his thinking.
Finally, this book has been made possible because of the strong desire of the family of Dr.
Mitsudo to publish his manuscripts. We would like to express our sincere appreciation to the
late Dr. Kazuaki Mitsudo and his family for the opportunity to be involved in the publication
of this book.
May he rest in peace.
KazushigeKadota
Kurashiki Central Hospital
Kurashiki, Japan
July 2016
vii
Acknowledgments
https://t.me/medicina_free
I am delighted that this English edition of the work of my late husband has reached completion. I hope that this posthumous collection of his extensive experience and teachings reaches
those professionals across the world undertaking their own endeavors in PCI, especially those
who worked with and supported him.
Last of all, I would like to express my sincere gratitude to those involved in the
translation.
Dr. Kazushige Kadota—Kurashiki Central Hospital
Dr. Takehiro Yamashita—Hokkaido Ohno Kinen Hospital
Dr. Jutaro Yamada—Saiseikai Shimonoseki General Hospital
Dr. Shingo Hosogi—Hosogi Hopital
Dr. Hiroyuki Tanaka—Kurashiki Central Hospital
Dr. Seiji Habara—Habara Heart Clinic
Ms. Makiko Kanaike—Kurashiki Central Hospital
Kazuyo Mitsudo
September 2020
ix
Contents
https://t.me/medicina_free
1 Mitsudo’s PCI Techniques for CTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Approach (Puncture Site) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Selection of the Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Sheath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.1 Selection of the Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.2 Anchoring Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.4 Anticoagulation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1.4.1 Administration of Heparin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1.4.2 Blood Sample Collection for ACT Measurement . . . . . . . . . . . . . . . . . . 20
1.4.3 Precautions When Collecting Blood via the Guiding Catheter . . . . . . . . 20
1.5 Fluoroscopy and Imaging Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
1.5.1 Video Imaging Equipment and Fluoroscopy Angles . . . . . . . . . . . . . . . . 21
1.5.2 Bilateral Angiography and Collateral Flow Angiography
(Contralateral Imaging, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
1.6 Antegrade Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
1.6.1 Mechanism of CTO Formation and Changes After Occlusion . . . . . . . . 35
1.6.2 Histological Features Before and After Occlusion . . . . . . . . . . . . . . . . . 38
1.6.3 Guidewire Crossing Based on the Presumed Mechanism of
CTO Formation and Changes After Occlusion . . . . . . . . . . . . . . . . . . . . 38
1.6.4 Guidewire Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
1.6.5 Microcatheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
1.6.6 Device Delivery Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
1.6.7 From Balloon Ination to Stent Placement . . . . . . . . . . . . . . . . . . . . . . . 93
1.7 Retrograde Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
1.7.1 Indications for the Retrograde Approach . . . . . . . . . . . . . . . . . . . . . . . . . 94
1.7.2 Collateral Channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
1.7.3 Selection of a Collateral Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
1.7.4 Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
1.7.5 Microcatheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
1.7.6 Fluoroscopy and Contrast Imaging Angles . . . . . . . . . . . . . . . . . . . . . . . 106
1.7.7 Tip Injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
1.7.8 Guidewire Selection and Handling for Each Channel Type . . . . . . . . . . 111
1.7.9 Conrmation of Channel Penetration . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
1.7.10 Advancing a Microcatheter into the Distal True Lumen . . . . . . . . . . . . . 116
1.7.11 Selection of (I) Guidewire, (II) CTO Penetration Strategy,
and (III) Guidewire Handling Technique . . . . . . . . . . . . . . . . . . . . . . . . . 117
1.7.12 Direct Crossing Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
1.7.13 Kissing Wire Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
1.7.14 Reverse CART Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
1.7.15 Introducing the Retrograde Guidewire into the Antegrade
Guiding Catheter After Crossing the CTO . . . . . . . . . . . . . . . . . . . . . . . . 131
xi
xii
https://t.me/medicina_free
1.7.16 Introducing the Retrograde Microcatheter into the Antegrade
Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
1.7.17 Switching to the Antegrade Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
1.8 Antegrade Approach Revisited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
1.8.1 Balloon Ination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
1.8.2 IVUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
1.8.3 Retry for Tracking the True Lumen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
1.8.4 From Pre-dilatation to Stenting and Post-dilatation . . . . . . . . . . . . . . . . 142
1.9 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
1.9.1 Guidewire Entrapment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
1.9.2 Perforation by the Guidewire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
1.9.3 Perforation or Laceration of a Retrograde Collateral Channel . . . . . . . . 150
1.9.4 Uncontrollable Bleeding: Management of Coronary
Perforation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
2 Stenting of Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
2.1 Dedicated Bifurcation Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
2.2 Optimizing General-Purpose Stents for Bifurcation Lesions . . . . . . . . . . . . . . .163
2.2.1 Temporary Link Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
2.3 Optimal Stenting Techniques for Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . 168
2.3.1 Need for KBI Pre-dilatation and Practical Approach . . . . . . . . . . . . . . . 168
2.3.2 KBI for Post-dilatation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
2.3.3 Basic Procedures for Stenting with KBI . . . . . . . . . . . . . . . . . . . . . . . . . 172
2.3.4 SB Wiring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
2.4 Ideal Double Stenting of Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
2.4.1 Comments on Various Two-Stent Methods . . . . . . . . . . . . . . . . . . . . . . . 194
2.4.2 Culotte (Y) Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Contents
3 Stenting of RCA Ostial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
3.1 Radial Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
3.2 Lesion Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
3.3 Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
3.3.1 Optimal Stent Design for RCA Ostial Lesions . . . . . . . . . . . . . . . . . . . . 201
3.3.2 Effect of Stent Fracture on the Vessel . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
3.3.3 Characteristics of the Nobori 3.5-mm JV Stent . . . . . . . . . . . . . . . . . . . . 204
3.4 Positioning the Stent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
3.4.1 Position of the Distal Stent Edge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
3.4.2 Position of the Proximal Stent Edge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
3.4.3 Stenting of RCA Ostial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
3.5 Necessity of Performing IVUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
3.6 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
4 Stenting of Left Main Coronary Artery (LM) Lesions . . . . . . . . . . . . . . . . . . . . . . 211
4.1 Lesion Pathomorphology and Stenting Techniques . . . . . . . . . . . . . . . . . . . . . . . 212
4.2 Stent Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
4.2.1 Conformability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
4.2.2 Maximum Expansion Diameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
4.2.3 Optimal Design of the Proximal Stent Edge for Ostial Stenting . . . . . . . 216
4.3 Lesion Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
4.3.1 Preparation of the LM Ostium and Trunk . . . . . . . . . . . . . . . . . . . . . . . . 218
4.3.2 Preparation of the Distal LM Bifurcation . . . . . . . . . . . . . . . . . . . . . . . . 218
4.3.3 Preparing the LAD/LCX Ostia and the Proximal LAD/LCX . . . . . . . . . 222
4.3.4 Practical Approach to Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Contents
https://t.me/medicina_free
xiii
4.4 Stenting Strategy and Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
4.4.1 Stenting a Relatively Long LM with Plaque Conned to the
Ostium or Part of the Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
4.4.2 Stenting the LM Bifurcation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
4.4.3 Stenting up to the Ostium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
4.4.4 Stent Edge in the LMT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
4.4.5 Culotte Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
4.4.6 T Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
4.5 LM Trifurcation Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
4.5.1 Stenting with (Triple) KBI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
4.5.2 Culotte Stenting at the LM Trifurcation . . . . . . . . . . . . . . . . . . . . . . . . .234
4.6 Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
5 Mitsudo’s Non-pushing PCI Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
5.1 When Is Pushing Allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
5.1.1 Microcatheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
5.1.2 Small-Diameter Balloon Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
5.1.3 Tornus Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
5.1.4 Backup for the Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
5.2 Guidewire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
5.2.1 Fundamentals of Advancing a Guidewire . . . . . . . . . . . . . . . . . . . . . . . . 247
5.2.2 Guidewire Manipulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
5.2.3 Rotating and Pushing a Guidewire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
5.2.4 Exploration with a Guidewire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
5.2.5 Guidewire Selection and Supplementary Wiring Techniques
(Crusade Microcatheter, Scoring Balloon [Lacrosse NSE
Balloon] Angioplasty, Reverse Wire Technique, etc.) . . . . . . . . . . . . . . . 248
5.3 Balloon Angioplasty (POBA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
5.3.1 Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
5.3.2 Balloon Size, Ination Pressure, and Ination Speed . . . . . . . . . . . . . . . 251
5.3.3 Mechanisms of Dissection and Countermeasures . . . . . . . . . . . . . . . . . . 252
5.3.4 Scoring and Cutting Balloon Angioplasty . . . . . . . . . . . . . . . . . . . . . . . . 253
5.4 Use of the Rotablator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
5.4.1 Tornus and RotaWire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
5.4.2 Debulking a Lesion at a Bend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
5.4.3 Reducing Guidewire Bias and Burr Bias . . . . . . . . . . . . . . . . . . . . . . . . . 254
5.4.4 Advancing a Burr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
5.5 ELCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
5.6 Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
5.6.1 General Precautions for Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
5.6.2 Using a Conformable Stent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
5.6.3 Using a Child Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
5.7 IVUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
5.8 Anchoring Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
5.8.1 Anchoring technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
5.8.2 Coaxial Anchoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270
5.8.3 Trapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
5.9 Guidewire Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
5.10 Removing an IVUS Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
5.10.1 If the IVUS Catheter Becomes Stuck during Withdrawal . . . . . . . . . . . . 271
5.10.2 If the IVUS Catheter Is Caught, But Not Stuck . . . . . . . . . . . . . . . . . . . . 273
Соседние файлы в папке Библиотека им академика М.И. Перельмана