Читать книгу Interventional Cardiology - Группа авторов - Страница 133

The buddy wire technique refers to the passage of a second or third guidewire distal to a target lesion to provide additional support for delivery of angioplasty equipment. This is a commonly used strategy for crossing difficult lesions with a balloon or a stent [7]. The additional wire provides a rail that facilitates advancement across calcification, tortuosity, or recently deployed stents. The wire facilitates active engagement of the guide catheter and can straighten tortuosity when a supportive wire is used. This technique is also the first essential step for the distal anchor balloon technique. Although it can at first appear to be counterintuitive, advancing an additional wire into a branch that lies proximal to the target lesion, this may increase support enough to allow passage of a balloon, stent, or additional wire along the first wire into the tortuous distal vessel (Figure 5.6) and is anyway the first step for a side branch anchoring technique [8]. Using a buddy wire is a simple strategy that can be facilitated using a dual lumen microcatheter in case of excessive tortuosity or presence of dissections post initial balloon dilatation. This avoids the risks of deep engagement or the delays and potential difficulties of upgrading the guide catheter. A floppy, steerable wire can advance easily and be exchanged using an OTW catheter for a wire with a more supportive shaft but soft flexible tip. The use of stiff hydrophilic wires as a “buddy wire” is discouraged because of the risk of perforation. Occasionally, if support from the guide and an additional wire still proves insufficient, additional techniques are needed and are delineated subsequently.