Endoscopic Retrograde Cholangiopancreatography

Endoscopic Retrograde Cholangiopancreatography

1. Overview of PCI
PCI Training Simulator I is a minimally invasive therapeutic method that uses cardiac catheterization technology to recanalize stenotic or occluded coronary arteries and improve myocardial perfusion. This technique covers balloon angioplasty, stent implantation and coronary assessment procedures, and can perform millimeter-level precise operations with the assistance of vascular interventional robots.

2. Development History of PCI
In 1844, Bernard first inserted a catheter into an animal's heart.In 1929, German physician Forssmann inserted a urinary catheter from his own elbow vein through the superior vena cava into the right atrium and took the first cardiac catheter X-ray film in medical history, pioneering the development of human cardiac catheterization technology. On this basis, right heart catheterization and left heart catheterization were subsequently developed one after another.

In 1953, Seldinger established the percutaneous vascular puncture technique, putting an end to the era of vascular incision for interventional operations.In 1958, during an aortography, Sones accidentally inserted the catheter into the right coronary artery and injected contrast agent to visualize the right coronary artery. This accidental yet risky event marked the beginning of modern coronary interventional technology.

In 1967, Judkins performed coronary angiography via femoral artery puncture, after which this technology was further developed and popularized in the diagnosis of coronary heart disease.In 1977, Gruentzig from Germany performed the first percutaneous transluminal coronary angioplasty (PTCA). Since then, PTCA technology spread rapidly from Europe to America with expanding indications. Related industrial products also developed rapidly, and various operating devices (such as catheters and balloons) were continuously optimized to address different lesions.

In 1986, Puol and Sigmart implanted the first coronary stent into the human body. Coronary stent implantation significantly reduced the restenosis rate of PTCA, managed arterial dissection and acute vascular occlusion, becoming another milestone in coronary interventional therapy.In 2003, drug-eluting stents (DES) were introduced into clinical practice, markedly lowering the stent restenosis rate and ushering coronary interventional therapy into a new era.
3. Indications for Interventional Therapy
Ⅰ：For patients with chronic stable coronary heart disease and evidence of extensive myocardial ischemia, interventional therapy is one of the effective methods to relieve symptoms.

Ⅱ：Early interventional therapy is recommended for high-risk patients with unstable angina and non-ST-segment elevation myocardial infarction.High-risk patients mainly include those with recurrent angina pectoris or myocardial ischemia, poor exercise tolerance under adequate medication, elevated serum cardiac enzyme levels, newly onset ST-segment depression on electrocardiogram, heart failure, new or aggravated mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, a history of interventional therapy within 6 months, and previous coronary artery bypass grafting.

Ⅲ：SanFor patients with acute ST-segment elevation myocardial infarction, the key to early treatment is to open the infarct-related artery (IRA), rescue viable myocardium as much as possible, reduce the acute mortality risk and improve long-term prognosis. Different strategies are adopted according to the patient's admission time and initial treatment:

(1) Primary PCI: Perform PCI to directly open the IRA within 12 hours after the onset of acute myocardial infarction. Primary PCI can achieve timely, effective and sustained recanalization of the IRA. It is recommended to control the door-to-balloon time within 90 minutes.Primary PCI should be performed for patients within 12 hours of onset (especially 3–12 hours), particularly those with contraindications to thrombolysis if conditions permit. It is also recommended for patients with onset over 12 hours but accompanied by ischemic symptoms, cardiac dysfunction, hemodynamic instability or severe arrhythmia. For patients with cardiogenic shock, the time window can be extended to 36 hours. PCI Training Simulator I is not recommended for patients over 12 hours of onset without any ischemic symptoms.

(2) Transfer PCI: Transfer patients to a hospital qualified for primary PCI if the initial hospital is unable to perform the procedure and immediate thrombolysis is not feasible.

(3) Rescue PCI: PCI performed on the IRA that remains occluded after failed thrombolysis.

(4) Facilitated PCI: Preemptively administer thrombolytic or antiplatelet drugs before scheduled PCI within 12 hours of onset to achieve early recanalization of the IRA.

4. Vascular Access Approaches for Intervention
Femoral artery approach: The femoral artery is thick with a high puncture success rate. Its disadvantages include prolonged postoperative bed rest and a higher incidence of puncture-related complications, such as bleeding, hematoma, pseudoaneurysm, arteriovenous fistula, and retroperitoneal hematoma.

Radial artery approach: It requires a short compression time after surgery without mandatory bed rest, causing less patient discomfort and fewer complications. It has gradually become the preferred access for current PCI Training Simulator I treatment.