经桡动脉介入治疗慢性完全性冠脉闭塞病变的可行性和安全性

Feasibility and Safety of a Transradial Approach in Intervention for Chronic Total Occlusion of Coronary Arteries A Single-center Experience

目的目前经桡动脉心导管检查越来越普遍,但是它应用在经皮冠脉介入(PCI)治疗慢性完全性冠脉闭塞(CTO)较少被报道。本研究考察经桡动脉(PCI)介入治疗CTO病变的可行性和安全性。方法我们回顾性研究了我院419例从2008年2月到2010年12月因慢性完全性冠脉闭塞而进行了PCI治疗的病人。分两组,一组经桡动脉手术400例,另一组经股动脉手术19例。结果两组基本临床特征相似。经桡动脉组比经股动脉组有更多的新病变发生率(76%vs47.37%,P=0.012),更少的术后支架内再狭窄发生率(11.75%vs36.84%,P=0.006)和使用更小的导管(P<0.001)。主要并发症的发生,如猝死、急性Q波心梗、紧急冠脉搭桥手术,两组没有显著性差异。结论经桡动脉PCI治疗CTO病变更优于经股动脉。我们强力推荐在冠脉造影,尤其是治疗CTO时,优先选择经桡动脉。如果手术失败是因为导管小支撑不足时选择经股动脉PCI并用大号导管。

objective The transradial approach for cardiac catheterization has become popular; however, its application in percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） has rarely been reported. This study examines the feasibility and safety of this approach for performing PCI for CTO lesions. Methods We retrospectively evaluated 419 consecutive patients who underwent PCI for CTO lesions between February 1998 and December 2003 in our hospital; a trans radial artery approach was used in 400 patients and a transfemoral artery approach in 19. Results The baseline clinical characteristics were similar in the 2 patient groups. The transradial group had more de novo lesions （76% vs 47.37%, p=0.012）, fewer in-stent restenotic lesions （11.75% vs 36.84%, p=0.006） and smaller guiding catheters （p〈0.001） than the transfemoral group. There was no statistical difference in the procedure success rates （69.25% and 78.95%, p=0.369） between the 2 groups. The incidence of major complications, including death, Q wave myocardial infarction, and emergency coronary artery bypass surgery, was similar in the 2 groups. Conclusion The transradial approach for PCI can be a feasible choice for a CTO lesion. If this approach fails because of poor back up support from the guiding catheter, the transfemoral approach can be attempted with a larger guiding catheter.