274例经皮桡动脉穿刺介入术治疗冠心病

Percutaneous transradial approach for coronary angiography or angioplasty

目的 探讨经桡动脉介入治疗冠心病的可行性和安全性。方法 6 0 8例冠心病患者分别经桡动脉 (2 74例 ,A组 )或经股动脉 (334例 ,F组 )途径接受介入治疗 ,观察两组手术成功率和术后并发症情况。结果 两组患者接受选择性冠状动脉造影 (CAG)或经皮腔内冠状动脉成形术 (PTCA)的手术成功率差异无显著性。A组局部血肿发生率显著低于F组 ,无假性动脉瘤 (F组 7例 ,P <0 0 5 )等其他血管及皮肤并发症 ,1例发生术侧肢体浮肿 ;F组出现 1例动静脉瘘、2例术侧肢体浮肿、4例穿刺部位感染、5例穿刺部位表皮坏死 ,但两组相比差异均无显著性。两组均无远端肢体缺血。结论 经桡动脉途径行经皮冠状动脉介入治疗术后并发症少 ,可行性高 ,安全有效 ,但需要一定的经验。

Objective To evaluate the practical clinical applicability and safety of coronary interventions performed through the radial artery. Methods 608 patients with coronary heart disease undergoing angiography or angioplasty were prospectively randomized to have their procedure performed from either the radial (274, group A) or femoral (334, group F) access site and the results compared. Exclusion criteria for transradial approach were the absence of radial pulse and abnormal Allen′s test. Results In three patients radial puncture was not successful (1.09%), and brachial artery access was necessary to complete the procedure. In group F, eight patients were not successful (2.40%, P>0.05). Minor hematoma occurred in four patients with transradial approach and in 59 with transfemoral approach (1.46% vs 17.78%, P<0.01). Major hematoma complications occurred in one patient of group A and 12 patients of group F (0.36% vs 3.59%,P>0.05), and two patients required blood transfusion in group F. None of the patients suffered from pseudoaneurysm, arteriovenous fistula, and ischemia of the hand. Conclusion Coronary angioplasty can be performed safely using the transradial approach with relatively few vascular complications and with better patient′s comfort.