经桡动脉穿刺的冠状动脉介入治疗

Transradial approach for coronary interventions

目的 探讨经桡动脉穿刺行冠状动脉介入治疗的可行性和安全性。方法 116例冠心病患者 (男 96例 ,女 2 0例 ,平均年龄 5 7 44± 9 40岁 )经桡动脉穿刺行冠状动脉介入治疗。结果 5例桡动脉穿刺失败改行股动脉穿刺 ,2例桡动脉穿刺虽成功但试行球囊扩张失败 ,其余患者均取得穿刺和介入治疗成功。共扩张病变血管 135支 (前降支 6 9支 ,回旋支 2 6支 ,右冠状动脉 39支 ,静脉桥血管1支 ) ,治疗病变 148处 (A型 15处 ,B型 10 6处 ,C型 2 7处 )。 98例患者的 10 5支血管植入支架共 110个 ,1例行旋磨术 ,1例行冠状动脉内超声检查。 2 5例患者术中须更换导引导管。术后穿刺局部大量出血需输血者 1例 ,局部较大血肿 2例 ,肘动脉分支穿孔 1例。结论 经桡动脉穿刺行冠状动脉介入治疗在临床上可行 ,但穿刺较困难 ,导引导管支撑力较差 ,应警惕局部血管损伤的可能。

Objective To study the feasibility and safety of transradial approach for coronary interventions Methods Coronary intervention was tried to be performed via transradial approach in 116 patients with coronary heart disease (96 males, 20 females, mean age 57 44±9 40 years) Results Transradial puncture failed in 5 cases and coronary interventions were performed via transfemoral approach instead Coronary intervention failed in 2 cases although transradial puncture succeeded Both transradial puncture and coronary intervention succeeded in the rest 109 cases One hundred and thirty five narrowed coronary arteries were dilated (69 LAD, 26 LCX, 39 RCA, 1 venous graft) One hundred and forty eight coronary lesions, including 15 type A, 106 type B and 27 type C lesions were treated One hundred and ten stents were implanted in 105 coronary arteries of 98 patients Rotablator was performed in one case and intracoronary ultrasound detected for another Changing guiding catheter was necessary for 25 cases during the procedure Transfusion was needed due to puncture site bleeding in one case Big hematoma was found in two cases Perforation of a branch of brachial artery happened in another case No surgery repair needed Conclusion Coronary intervention via transradial approach was feasible, but the radial artery puncture was somewhat difficult, and guiding catheter support is poor to some extent One must be cautious about vascular damages near the puncture site