应用5F指引导管经桡动脉通路冠状动脉介入治疗(摘要)

Using 5 French guiding catheters in the percutaneous transluminal coronary intervention trans-radial

目的 :评价应用 5F小腔径指引导管经桡动脉冠状动脉 (冠脉 )腔内成形术 (PTCA)和支架术的可行性、安全性 ,探讨其应用策略。方法 :①对象 :经冠脉造影证实冠脉病变需进行PTCA和支架置入的 12 0例患者 ,男 10 0例 ,女 2 0例 ,平均年龄 65 (11岁 ;单支病变 86例 (71.6% ) ,双支病变 18例 (15 % ) ,三支病变 14例 (11.7% ) ,静脉旁路血管病变 2例 (1.7% )。②材料 :12 0例均应用MedtronicAVE 5FZ2指引导管。右冠病变 43例中有 2 9例 (67.4% )应用Judkins右冠导管 ,10例 (2 3 .3 % )应用Amplatz左冠导管 ,4例 (9.3 % )应用Amplatz右冠导管。 92例患者的 12 1处左冠病变 ,61例 (66.3 % )应用Judkins左冠导管 ,17例 (18.5 % )应用EBU导管 ,14例 (15 .2 % )应用Amplatz左冠导管。 2例静脉旁路血管病变均应用Judkins右冠导管。③手术通路 :96例 (80 % )经右侧挠动脉 ,2 4例 (2 0 % )经左侧挠动脉。结果 :对 12 0例患者的 166处病变 (左主干 3例 ,左前降支 77例 ,左回旋支 41例 ,右冠 43例 ,静脉旁路 2例 )进行了治疗 ,其中 119处 (71.7% )直接支架置入 ,42处 (2 5 .3 % )PTCA后支架置入 ,5处 (3 % )支架置入未成功 ,仅行PTCA ;置入支架 161枚 ,直径 2 .5 -4mm ,长度 8-3 3mm。治疗前后病变血管平均狭窄程度分别?

Objective:To evaluate the feasibility and safety of using 5 French guiding catheters in coronary angioplasty and stenting trans-radial, to explore the strategy for choice of guiding catheters curves. Methods:①Subjects: A consecutive series of 120 patients with coronary disease that need angioplasty and stenting were included. Among them, 88 of one vessel disease, 18 of double vessel diseases, 14 of three vessel diseases. Their average age was 65±11 years. ②Choice of guiding catheters: Only Medtronic 5F guiding catheters were used in this study. Right Judkins catheters in 29 cases (67.4%), left Amplatz catheter in 10 cases (23.3%) and right Amplatz catheter in 4 cases (9.3%) for 43 right coronary lesions. Left Judkins catheter was used in 61 cases (66.3%), EBU catheter in 17 cases (18.5%) and left Amplatz catheter in 14 cases (15.2%) for 121 left coronary lesions in 92 patients; Right Judkins catheters in 2 cases of saphenous vein grafts were used. ③Artery approach: Trans-radial left in 96 cases (80%), trans-radial right in 24 cases (20%). Results:One hundred and sixty-six lesions of 120 patients were treated, 3 lesion in left main coronary artery, 77 in left anterior descending artery, 41 in circumflex, 43 in right coronary artery and 2 in saphenous vein grafts. Among 166 lesions, 119 lesions (71.7%) were directly stented, and 42 lesions (25.3%) were dilated with balloon and then stented. 5 lesions (3%) were only dilated with balloon because of failure of stenting. A total of 161 stents were implanted, with diameters ranging from 2.5mm to 4mm and lengths from 8mm to 33mm. Average stenos rate was 86.4±6.6% before stenting and 8.6±2.6% after stenting. The complication of vascular access site occurred only in one patient (0.8%), which was occlusion of arteria radial but without isocheim of hand. Conclusions:Using 5 French guiding catheters in coronary angioplasty and stenting were both feasible and safe with a very low risk of coronary and access site complications. However it is necessary to know well the strategy for choice of guiding catheters curves in order to obtain an easier and safer operation.