摘要
背景经桡动脉入径行冠状动脉介入诊疗后桡动脉闭塞(RAO)发生率较高,但目前尚缺少关于经远端桡动脉入径(dTRA)逆向开通闭塞桡动脉的大样本量、长期随访研究。目的评估dTRA逆向开通闭塞桡动脉的可行性。方法连续纳入深圳市人民医院心血管内科2019年6月—2021年12月收治的TRA行冠状动脉介入诊疗后出现RAO的患者44例。主要观察指标为dTRA逆向开通闭塞桡动脉成功率,次要观察指标包括d TRA逆向开通闭塞桡动脉失败的可能预测因素、住院期间并发症发生情况及术后3、6、12个月桡动脉通畅率。结果本研究dTRA逆向开通闭塞桡动脉成功率为88.6%(39/44),根据dTRA逆向开通闭塞桡动脉情况分为成功组(n=39)与失败组(n=5)。失败组患者糖尿病病史、吸烟、慢性冠状动脉完全闭塞比例高于成功组,行球囊成形术比例低于成功组(P<0.05)。两组患者既往行冠状动脉介入诊疗次数比较,差异有统计学意义(P<0.05);两组患者住院期间穿刺部位出血、血肿发生率比较,差异无统计学意义(P>0.05)。成功组患者术后3、6、12个月桡动脉通畅率分别为48.7%(19/39)、43.6%(17/39)、35.9%(14/39)。结论d TRA逆向开通闭塞桡动脉具有可行性,成功率高达88.6%,但远期通畅率低于50.0%;糖尿病、吸烟、既往行冠状动脉介入诊疗次数、慢性冠状动脉完全闭塞、未行球囊成形术可能是d TRA逆向开通闭塞桡动脉失败的影响因素;推荐RAO同时需择期行冠状动脉介入诊疗的患者dTRA逆向开通闭塞桡动脉。
Background The incidence of radial artery occlusion(RAO)after coronary intervention via transradial artery approach(TRA)is high.But there is a lack of long-term follow-up studies with a large sample size on retrograde recanalization of occluded radial artery via distal transradial artery approach(dTRA).Objective To assess the feasibility of dTRA for retrograde recanalization of occluded radial artery.Methods Forty-four patients undergoing retrograde recanalization via dTRA for treating RAO after coronary intervention via TRA were consecutively recruited from Shenzhen People's Hospital from June 2019 to December 2021.The primary observation index was postprocedural radial artery patency.And secondary observation index included possible predictors of failed retrograde recanalization,incidence of adverse events during hospitalization,and patency rates of radial artery at 3,6 and 12 months after procedure.Results The success rate of postprocedural radial artery patency was 88.6%(39/44),and divided into groups of successful(n=39)and failed(n=5)according to the result of the procedure.Compared with the successful group,the failed group had higher percentages of diabetics,current smokers and chronic total occlusion of the coronary artery,as well as a significantly lower prevalence of undergoing balloon angioplasty(P<0.05).There was significant intergroup difference in the times of coronary interventions(P<0.05);there was no significant intergroup difference in the incidence of bleeding or hematoma at the access site during hospitalization(P>0.05).The patency rates of radial artery in successful group were 48.7%(19/39),43.6%(17/39),and 35.9%(14/39)at 3,6,and 12 months after procedure,respectively.Conclusion The dTRA may be feasible for retrograde recanalization of occluded radial artery,which showed a high procedural success rate up to 88.6%,but the long-term patency rate was less than 50.0%.Diabetes,smoking,times of coronary interventions,chronic total occlusion of coronary artery,and receiving no balloon angioplasty may be influencing factors of failed retrograde recanalization of occluded radial artery via dTRA.And dTRA for retrograde recanalization of occluded radial artery is recommended for patients with RAO who also require elective coronary intervention.
作者
袁铭培
林耀望
贝伟杰
刘华东
董少红
孙鑫
YUAN Mingpei;LIN Yaowang;BEI Weijie;LIU Huadong;DONG Shaohong;SUN Xin(Department of Cardiology,Shenzhen People's Hospital/the Second Clinical Medical College of Jinan University/the First Affiliated Hospital of Southern University of Science and Technology,Shenzhen 518020,China;Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center,Shenzhen 518020,China)
出处
《中国全科医学》
CAS
北大核心
2023年第27期3373-3377,共5页
Chinese General Practice
基金
深圳市医学重点学科建设经费资助(SZXK003)
深圳市医疗卫生三名工程项目(SZSM201412012)。
关键词
冠心病
冠状动脉疾病
经皮冠状动脉介入治疗
冠状血管造影术
动脉闭塞性疾病
远端桡动脉
桡动脉闭塞
前瞻性研究
可行性研究
Coronary disease
Coronary artery disease
Percutaneous coronary intervention
Coronary angiography
Arterial occlusive diseases
Distal radial artery
Radial artery occlusion
Prospective studies
Feasibility studies
