经桡动脉介入治疗冠状动脉慢性闭塞病变的临床分析

A clinic study of transradial percutaneous coronary intervention in patients with chronic total occlusion.

目的分析经桡动脉对冠状动脉慢性闭塞性(CTO)病变进行介入治疗的可行性、临床效果和手术成功的影响因素。方法回顾2003年1月至2006年6月首都医科大学附属北京安贞医院心内科156例患者187处CTO病变经桡动脉行介入治疗的资料。分析开通组(135处病变)和未开通组(52处病变)的临床、介入影像特征、器械应用、主要并发症等情况。结果187处CTO病变中135处病变经桡动脉成功开通,52处病变未能开通,成功率72%;两组临床特征、病变血管位置、直径差异无统计学意义。开通组与未开通组病变形态、长度、时间差异均有统计学意义(P<0.05):锥形病变71%对52%,平齐病变29%对48%。钙化病变14%对40%,桥侧支12%对35%,闭塞时间(5.2±4.3)个月对(9.2±5.4)个月。病变长度≤15 mm 87%对15%,病变长度>15 mm13%对85%。失败原因主要是导引钢丝或球囊未能通过病变部位。多元分析显示CTO持续时间是影响开通率最重要的因素。术后发生前臂血肿1例,桡动脉闭塞1例,未见其他严重并发症。结论经桡动脉介入治疗CTO病变安全可行,成功率较高,无严重并发症。

Objective To observe the feasibility and safety of transradial coronary intervention in 156 patients with chronic total occlusion（CTO）. Methods A total of 156 patients [ 86 males and 70 females, mean age （65. 18 ± 11.19 ）years ] were admitted from June 2003 to December 2006. Clinical and angiographic characteristics, devices, and complications in success （135 lesions）and failure group （52 lesions）were collected. Results There were 135 target vessels with total occlusion leisons in the TRI group. An overall success rate （72%, 135 of 187 lesions）was achieved with TRCI. The most significant predictor of failure was the duration of occlusion. There were no diffence in clinical, target vessels＇ morphous and diameter between success and failure group. There were no major complications, statistical difference were found in morpho us,length,duration of lesions（P 〈0. 05）. The most common cause in failure group was inability to pass the lesions for a guidewire or a ballon. The duration of CTO was the most markable predictor in failure group. There were no severe complications in all patients. Conclusion Transradial PCI might be a feasible and safe route for CTO with relative high successful rate and no access site complications.