经鼻烟窝处远端桡动脉入路冠状动脉介入治疗在身高180~188 cm患者中的安全性和可行性分析

Feasibility and Safety of Snuffbox Distal Radial Artery Interventional Therapy for Coronary Heart Disease Patients With Height 180-188 cm

目的:探讨身高180~188 cm患者中应用现有器械实施经鼻烟窝处远端桡动脉入路冠状动脉(冠脉)造影和介入治疗的可行性及安全性。方法:连续入选2021年8月至2022年4月在我院接受经鼻烟窝处远端桡动脉入路冠脉造影或介入治疗的130例患者,按身高分为身高180~188 cm组(n=44)和身高<180 cm组(n=86)。收集两组患者人口基线特征、临床基本资料和用药情况、病变特点以及手术入路血管迂曲情况,比较两组穿刺时间、冠脉造影和经皮冠脉介入治疗(PCI)时间、对比剂用量、曝光时间、操作成功率及穿刺相关并发症(血管并发症、桡动脉闭塞率)的差异。结果:两组造影导管到位成功率均为100%(身高180~188 cm组1例因路径动脉迂曲改良导管后成功)。身高180~188 cm组和身高<180 cm组穿刺时间[(3.40±1.89)min vs.(3.62±2.50)min],造影时间[(11.48±2.98)min vs.(12.02±5.48)min],PCI时间[(45.14±34.81)min vs.(45.04±25.64)min],放射剂量[(2092.48±1893.38)mGy vs.(1719.36±1320.37)mGy],曝光时间[(924.20±859.99)s vs.(939.60±761.81)s],对比剂用量[(132.73±80.39)ml vs.(134.71±68.31)ml],术后压迫时间[(3.14±0.88)h vs.(2.95±0.30)h],差异均无统计学意义(P均>0.05);两组患者介入操作成功率均为100%,且均无严重并发症出现,身高180~188 cm组和身高<180 cm组出现桡动脉痉挛的患者分别为5例(11.4%)和7例(8.1%),出现拇指麻木感的为2例(4.5%)和3例(3.5%),差异均无统计学意义(P均>0.05)。术后24 h两组均无桡动脉闭塞发生。结论:本研究初步显示,对于身高180~188 cm且锁骨下动脉无严重迂曲的患者,利用现有器械实施经鼻烟窝处远端桡动脉入路的冠脉造影和介入治疗安全可行。

Objectives:To investigate the feasibility and safety of interventional therapy via snuffbox distal radial artery in patients with height 180-188 cm.Methods:From August 2021 to April 2022,all patients admitted to Fuwai Hospital who underwent interventional therapy via distal radial artery were enrolled.The patients were divided into two groups:height 180-188 cm group and less than 180 cm group.The baseline characteristics,clinical data,medication,coronary lesions type and vessel tortuous status were recorded.The puncture time,the duration of coronary angiography and coronary intervention,the volume of contrast,time of x-ray,success rate of operation,puncture related complication including vascular complications and radial artery occlusion were compared between the two groups.Results:A total of 130 patients,including 44 cases with height 180-188 cm,86 cases with height less than 180 cm,were included in this study.Coronary angiography with diagnostic catheter was successful in all patients in both groups,one patient with tortuous subclavian artery finished coronary angiography successfully after modified catheter in height 180-188 cm group.There were no difference between the two groups in puncture time([3.40±1.89]min vs.[3.62±2.50]min),coronary angiography time([11.48±2.98]min vs.[12.02±5.48]min),percutaneous coronary intervention time([45.14±34.81]min vs.[45.04±25.64]min),dose of radiation([2092.48±1893.38]mGy vs.[1719.36±1320.37]mGy),time of X-ray exposure([924.20±859.99]s vs.[939.60±761.81]s),volume of contrast agent([132.73±80.39]ml vs.[134.71±68.31]ml)and the compression time after procedure([3.14±0.88]h vs.[2.95±0.30]h),all P>0.05.There were no failure cases and no severe complications in the two groups.Radial artery spasm occurred in 5 cases in height 180-188 cm group and 7 cases in less than 180 cm group.There were no complications and the radial artery pulsated well on the second day after procedure.Conclusions:This study demonstrated that interventional therapy via snuffbox distal radial artery is safe and feasible for patients with height 180-188 cm and without severe tortuosity of the subclavian artery.