经双侧桡动脉逆向导丝技术开通慢性完全闭塞病变的临床应用

The clinical application of PCI for chronic total occlusion using retrograde technique via bilateral radial artery approach

目的:探讨经双侧桡动脉逆向导丝技术开通慢性完全闭塞病变(CTO)的可行性和有效性。方法:共入选31例CTO患者,经双侧桡动脉逆向导丝技术行冠状动脉(冠脉)介入治疗(PCI),回顾性分析其临床资料。结果:桡动脉无动脉鞘技术74.2%。靶血管分布:左前降支(LAD)64.5%,右冠脉(RCA)32.3%,左回旋支(LCX)3.2%。间隔支侧支80.6%,心外膜侧支19.4%。反向CART技术16.1%。应用冠脉导丝数量(6.6±2.6)条。闭塞病变处平均植入支架(2.3±0.8)枚。逆向导丝技术的成功率87.1%。手术时间(157.4±36.9)min,造影剂用量(445.2±117.9)ml,X线曝光量(57 873.6±23 136.6)μGym2。间隔支损伤16.1%,前臂血肿12.9%。结论:经双侧桡动脉逆向导丝技术开通CTO病变是可行和有效的,但存在手术时间长、器械选择复杂、X线曝光量大、并发症高等特点。

Objective：To evaluate the safety and feasibility of percutaneous coronary intervention（PCI）for chronic total occlusion（CTO）using retrograde technique via bilateral radial artery approach.Method：Thirty-one patients with CTO received PCI which using retrograde technique via bilateral radial artery approach,the clinical data were analyzed retrospectively.Result：Transradial approach with sheathless technology 74.2%.The target vessel distribution was LAD 64.5%,RCA 32.3%,LCX 3.2%.Septal collaterals was 80.6%,epicardial collaterals was 19.4%.The technique of reverse CART was 16.1%.The mean number of coronary wires was（6.6±2.6）.The mean number of stents was（2.3±0.8）.The overall success rate of retrograde technique was 87.1%.Operating time was（157.4±36.9）minutes,contrast agent dosage was（445.2±117.9）ml,X-ray volume was（57 873.6±23 136.6）μGym^2.Septal collaterals injury was 16.1%,and forearm hematoma was 12.9%.Conclusion：The retrograde technique via bilateral radial approach for CTO is safe and feasible,but the retrograde technique has the features of long operating time,complicated equipment choosing,high X-ray volume,high complications incidence rate.