经鼻烟壶区远端桡动脉入路在冠状动脉造影和经皮冠状动脉介入治疗中的效果和安全性分析

Efficacy and Safety of the Distal Transradial Approach in Coronary Angiography and Percutaneous Coronary Intervention

目的:分析经鼻烟壶区远端桡动脉入路(d TRA)在冠状动脉造影和经皮冠状动脉介入治疗(PCI)中的效果和安全性。方法:纳入2020年1月至6月在石河子市人民医院经鼻烟壶区dTRA行冠状动脉造影和PCI的患者120例。观察患者术后出血相关并发症。患者在术前、术后3 d和1个月时应用血管超声观察桡动脉和远端桡动脉的闭塞发生率、血管管腔直径以及横截面积的变化。结果:120例患者中,5例穿刺失败,远端桡动脉穿刺成功率为95.8%;另有7例导丝上行困难,更改为桡动脉穿刺,置管成功率为90.0%(108/120);40例(37.0%,40/108)行PCI,术后仅1例穿刺部位少量出血,无皮下血肿发生。血管超声检查结果表明,与桡动脉管腔直径比较,远端桡动脉管腔直径术前[(2.50±0.39)mm vs.(2.88±0.45)mm]、术后1个月[(2.38±0.45)mm vs.(2.77±0.46)mm]均较小,远端桡动脉管腔面积术前[(5.05±1.61)mm^(2)vs.(6.78±2.52)mm^(2)]、术后1个月[(4.58±2.24)mm^(2)vs.(6.29±2.08)mm^(2)]均小于桡动脉管腔面积,差异均有统计学意义(P均<0.05);术后1个月,1例(1.6%)患者血管超声发现桡动脉闭塞。所有患者均无远端桡动脉闭塞。结论:远端桡动脉穿刺具有较高的成功率,行冠状动脉造影及PCI安全、有效,术后出血相关并发症发生率低,桡动脉闭塞发生率低。

Objectives:To analyze the efficacy and safety of the distal radial artery approach(dTRA)through the snuff bottle area for coronary angiography(CAG)and percutaneous coronary intervention(PCI).Methods:From January to June 2020,120 patients who underwent CAG and PCI via dTRA in the snuff bottle area in Shihezi Hospital of Xinjiang were enrolled.The complications related to postoperative bleeding were observed.The incidence of occlusion,vessel diameter and cross-sectional area of the radial artery and distal radial artery were assessed by vascular ultrasound before the procedure,at 3 days and 1 month after procedure.Results:Among 120 patients,dTRA puncture failed in 5 cases,and the success rate of dTRA was 95.8%.Another 7patients experienced difficulty in approaching the guide wire to the desired location and radial artery puncture was performed in these patients,and the catheterization success rate od dTRA was 90%(108/120).Forty cases(37.0%,40/108)underwent PCI,small amount of bleeding at the puncture site was observed in 1 case,and there was no subcutaneous hematoma.The results of vascular ultrasonography showed that the diameter of the distal radial artery lumen was significantly smaller than that of radial artery before operation([2.50±0.39]mm vs.[2.88±0.45]mm,P<0.05)and at one month after operation([2.38±0.45]mm vs.[2.77±0.46]mm,P<0.05).The cross-sectional area of the distal radial artery was also significantly smaller than that of radial artery before procedure([5.05±1.61]mm^(2)vs.[6.78±2.52]mm^(2),P<0.05)and at one month after procedure([4.58±2.24]mm^(2)vs.[6.29±2.08]mm^(2),P<0.05).One month after the procedure,one patient developed the occlusion of the radial artery(1.6%)confirmed by vascular ultrasound,and there was no distal radial artery occlusion.Conclusion:dTRA puncture is safe and associated with high success rate for CAG and PCI.