講演情報
[SY25-3]ガイドワイヤーの通過位置を「気にかけるべきか」
仲間 達也 (東京ベイ・浦安市川医療センター 循環器内科)
EVT for CTO of the femoropopliteal artery, "True lumen passage (TP)" vs "Subintimal lumen passage (SP)" has been long debated. There is no definitive evidence demonstrating the superiority of the TP. <BR> Globally, the evidence on this issue does not verify the actual route of the guidewire using IVUS, but instead categorizes techniques based on "crossing techniques". Discussions without clear understanding of the actual guidewire pathway are ultimately unproductive. <BR> Several studies "from Japan" have investigated the true versus subintimal pathway based on IVUS findings. The consensus from these investigations suggests deep SP (DOSABU: intra-media) can result in insufficient vessel expansion and may worsen clinical outcomes. In contrast, moderate subintimal (subintima) and true lumen (intraplaque) paths appear to produce similar outcomes. <BR> At present, there is NO large-scale evidence demonstrating that TP significantly improves clinical outcomes. In other words, techniques that pursue exclusively intraplaque wiring at the expense of significant time and cost?what may be described as a "cultural" practice in Japan?are likely not efficient. <BR> Most global evidence is derived from clinical results that do not adhere to guidewire pathway, and I am concerned that Japan’s adherence to its own "cultural approach" may risk falling out of step with international trends.