经桡动脉行复杂冠状动脉病变的介入治疗

Transradial percutaneous coronary angioplasty for patients with coronary artery complex lesions

目的探讨经桡动脉行复杂冠状动脉病变介入治疗的可行性。方法将178例左主干开口病变、分叉病变、慢性闭塞病变、长度≥30mm的长病变、纡曲成角病变及严重钙化病变等复杂冠状动脉病变患者经桡动脉途径进行PCI。结果经桡动脉PCI完成率97.2%。因导引导管支撑力不够,采用双导丝技术18例,采用子母导管技术5例,微导管技术6例,锚技术3例。左主干开口病变8处即刻全部成功。左主干分叉病变双支架置入17例,单支架置入9例。其他分叉病变67处,单支架置入47处,双支架置入20处。双支架置入后对吻球囊扩张成功率100%。34处慢性闭塞病变PCI成功27处。长度≥30mm的长病变91处、纡曲成角病变23处、严重钙化病变27处全部PCI成功。术中支架内血栓2例,住院期间亚急性血栓形成2例。死亡1例。穿刺处并发症:桡动脉闭塞8例,前臂肿胀4例,无血肿及神经损伤。结论经桡动脉途径进行冠状动脉复杂病变的PCI有较高的成功率。

Objective To study the feasibility of transradial percutaneous coronary angioplasty for patients with coronary artery complex lesions. Methods 178 patients with coronary artery com plex lesions,including lesion of ostium of left main stem, bifurcation lesion, chronic total occlusion （CTO） lesion,long lesion（≥30 mm）,severely calcified lesion and tortuosity lesion,were treated with transradial percutaneous coronary angioplasty. Results The clinical success via transradial approach was obtained in 97.2% of cases. Because the guiding catheter support was poor to some extent, double wire technique was used in 18 cases, son-in-mother catheter technique in 5, microcatheter technique and anchoring technique in 6 and 3 respectively. Procedural success rate for the lesions of ostium of left main stem was 100% in 8 patients. Successful double stents implantation for bifurcation lesions of left main stem was accomplished in 17 cases. Single stenting was used in 9 cases. Procedures succeeded in the rest 67 bifurcation lesions,including single stenting in 47 and double stenting in 20 lesions. The technique using double stents with subsequent kissing balloon post dilatation was employed with 100% success rate. Successful stenting for CTO lesion was accomplished in 27/34 of the cases. Technical success was obtained in 91 long lesions（≥30 mm） ,23 tortuosity lesions and 27 calcified lesions, with a success rate of 100%. Acute stent thrombosis was detected in 2 patients. During their hospital stay, 1 patient died after PCI, and 2 patients had subacute stent thrombosis. Complications at the puncture site included obliteration of radial artery in 8 cases, swelling and discomfort at the punctured limb in 4 cases. No hematoma or injury of nerve occurred. Conclusion Success rate of transradial percutaneous coronary angioplasty for coronary artery complex lesions was high.