经桡动脉介入治疗无保护左主干病变的可行性与安全性研究

The feasibility and safety of percutaneous transradial coronary intervention for unprotected left main coronary artery lesion

目的探讨经桡动脉行无保护左主干病变介入治疗的可行性和安全性。方法回顾性分析92例行介入治疗的无保护左主干病变患者,其中经桡动脉途径49例,经股动脉途径43例,观察两组患者的临床特征、病变特点、器械选择、并发症及主要心脏不良事件(MACE)。结果临床特征、复杂分叉病变、手术成功率两组之间差异无统计学意义(均为P>0.05);支架直径、长度,支架释放压力与最大扩张压力两组之间差异无统计学意义(均为P>0.05)。手术时间、投照时间、造影剂用量两组之间差异无统计学意义(均为P>0.05)。桡动脉组与股动脉组比较,术后住院时间较短[(2.2±0.4)d比(3.3±0.5)d](P<0.01)、局部血管并发症较少[2.0%(1/49)比14.0%(6/43),P<0.05]。12个月的随访期间两组MACE率相似[8.2%(4/49)比7.0%(3/43),P=0.83]。结论经桡动脉行无保护左主干病变介入治疗缩短了住院时间,减少了外周血管并发症,具有良好的可行性与安全性。

Objective To evaluate the feasibility and safety of percutaneous coronary intervention（ PCI） for unprotected left main coronary artery lesion by transradial approach. Methods A retrospective analysis of 92 cases of interventional treated patients with unprotected left main lesion was performed,including 49 cases by radial artery approach and 43 cases by femoral arterial approach,observing the clinical features,lesion characteristics,equipment selection,the complications and major adverse cardiac events（ MACE） between the two groups. Results There was no statistically significant difference in clinical features,complex bifurcation lesions,or surgical success rate between two groups（ all P〉0. 05）. There was no statistically significant difference in stents diameter,length,release pressure or the maximum expansion pressure between two groups（ all P〉0. 05）. There was no statistically significant difference in operation time,exposure time,or dosage of contrast agent between two groups（ all P〉0. 05）. In transradial group post operation hospitalization duration was significantly shorter-（ 2. 2 ± 0. 4） days vs.（ 3. 3 ± 0. 5）days（ P〈0. 01）,the rate of local vascular complications was significantly lower 2. 0%（ 1 /49） vs. 14. 0%（ 6 /43）（ P〈0. 05）,comparing with transfemoral group. However,the rate of MACE in 12 months follow-up was similar in two groups 8. 2%（ 4 /49） vs. 7. 0%（ 3 /43）（ P = 0. 83）. Conclusions PCI for unprotected left main coronary artery lesion by transradial approach can shorten the duration of hospital stays,reduce the peripheral vascular complications and have good feasibility and safety.