导丝联合球囊辅助360°迂曲桡动脉拉直技术完成冠状动脉介入操作的初步探讨

Preliminary study on coronary artery interventional procedure assisted by guide wire and balloon assisted 360°twisting radial artery straightening technique

目的 对通过360°迂曲(环状迂曲)桡动脉完成冠状动脉介入诊疗操作进行初步探讨。方法 回顾性分析2015年1月1日至2023年6月30日山东第一医科大学第一附属医院15例环状迂曲右桡动脉的患者成功经桡动脉路径完成冠状动脉介入诊疗,并对经环状迂曲桡动脉的操作进行了总结。结果 本研究中15例患者均通过环状迂曲桡动脉完成了冠状动脉造影(CAG);对于存在环状迂曲桡动脉的患者经迂曲桡动脉行经皮冠状动脉介入治疗(PCI)时,通过经皮冠状动脉腔内成形术导丝结合直径2.0mm球囊(6~8atm膨胀状态)辅助指引导管通过环状迂曲桡动脉后,交换为J形造影导丝将迂曲桡动脉部分拉直的状态下完成后续的CAG和PCI。左侧冠状动脉及右侧冠状动脉均可以通过该技术完成PCI,术后未出现前臂血肿及血管破裂等并发症。结论 导丝联合球囊的技术能够成功辅助导管通过环状迂曲桡动脉完成冠状动脉介入诊疗。

Objective Coronary arteriography(CAG)and percutaneous coronary intervention(PCI)are the most effective methods for the treatment of coronary atherosclerotic heart disease(CAD),but radial artery vascular variation,especially the presence of 360°tortuous(annular tortuous)radial artery seriously affects the success rate of trans-radial artery approach(TRA)interventional operation.This article provides a preliminary exploration of CAG and PCI through the annular tortuous radial artery.Methods We retrospectively analyzed 15 patients with annular tortuous right radial artery who successfully completed CAG or PCI by annular tortuous radial artery,and summarized the procedures performed through the annular tortuous radial artery.Results We found that the annular tortuous radial artery could be passed through by the catheter with the assistance of percutaneous transluminal coronary angioplasty(PTCA)guide wire or combined with a diameter of 2.0 mm balloon(6-8 atm dilatation state),and then the PTCA wire and the balloon can be replaced with a coronary angiography guide wire after the catheter passed through annular tortuous radial artery,and finally the annular tortuous radial artery could be straightened by fixing the coronary angiography guide wire and rotating and pulling the catheter.Finally,the catheter could be advanced to the coronary orifice and subsequent CAG or PCI could be performed while the annular tortuous radial artery was kept straightening.Both the left and right coronary arteries could perform coronary intervention using this technique,and there were no complications such as forearm hematoma or vascular rupture after this operation.Conclusions It is possible to successfully complete the coronary interventional therapy through annular tortuous radial artery by using the technique with the help of PTCA wire combined with balloon.