经桡动脉行冠脉造影及介入中上肢径路异常时PTCA导丝的应用价值

Significance of PTCA guide wire in abnormal upper limb vasculature during transradial coronary angiography and intervention

目的 探讨经桡动脉途径行冠状动脉造影及介入术中,上肢血管异常时PTCA导丝的应用价值.方法 我院近3年行桡动脉造影及介入治疗2000例,如果0.035”J型导丝和亲水超滑导丝在右上肢血管推送过程中遇到阻力,遂撤出导丝,进行上肢局部血管造影.疑似桡动脉痉挛的,局部推注维拉帕米100～200μg后再次复查血管造影.结果仍有40例未能成功,其中桡动脉环9例、严重桡动脉狭窄18例、桡动脉发育细小8例、桡动脉痉挛5例,随机分成PTCA导丝组和改股动脉组.PTCA导丝组改用PTCA导丝,最终完成冠状动脉造影检查;改股动脉组直接经股动脉途径行冠状动脉造影术.比较两组手术成功率、操作时间、造影剂用量及局部出血、血肿并发症等情况.结果 两组完成冠状动脉造影成功率比较未见统计学差异（95％比100％,P=0.746）.PTCA导丝组操作时间长于改股动脉组[（950.0±125.3）s比（710.0±98.3）s,P=0.032].两组造影剂用量比较未见统计学差异[（50.0±6.3）ml比（47.0±5.9）ml,P=0.18].改股动脉组出血、血 肿并发症多于PTCA组（20％比0％,P=0.035）.结论 经桡动脉途径行冠状动脉造影及介入治疗术中,当上肢血管发生异常,常规导丝不能完成时,换用PTCA导丝,操作轻柔,并发症发生率低,是安全有效的,特别对不适合经股动脉造影的患者尤为适合.

Objective To evaluate the value of PTCA guidewire in abnormal upper limb vasculature during transradial coronary angiography and intervention. Methods A total of 2000 patients underwent transradial coronary angiography and intervention in past three years in our hospital. Guide wire and local angiography were performed in the upper limb if pushing 0.035 ＂J type guidewire and hydrophilie super smooth guide wire encountered resistance in the fight upper limb vasculature. When radial artery spasm was suspected, 100-200 μg verapamil was injected and local angiography was performed again. However, there were still 40 cases failed, including 9 cases of radioulnar loop, 18 cases of severe radial artery stenosis, 8 cases of small radial artery, 5 cases of radial artery spasm. We randomized the 40 cases into two groups： one group was switched to PTCA guidewire, another group was reverted to transfemoral approach. The operation success rate, operation time, amount of contrast media usage and complications of local hemorrhage and hematoma were compared. Results The success rate was not significantly different （95% vs 100%, P=0.746）. Procedure duration was longer in PTCA guidewire group [（950.0±125.3）s vs （710.0±98.3）s, P=0.032]. The amount of contrast media usage was not significant [（50.0± 6.3 ）ml vs （47.0±5.9）ml, P=0.18 ]. Complications of local hemorrhage and hematoma were more in femoral artery group（20% vs 0%, P=0.035 ）. Conclusion PTCA guide wire is safe and effective during transradial coronary angiography and intervention when upper limb vasculature was abnormal and conventional guidewire cannot be completed. It is especially suitable for patients who do not fit the femoral artery.