| 摘要: |
| 目的 探讨经桡动脉介入治疗(transradial intervention,TRI)过程中应用经皮冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝置入鞘管及完成冠状动脉造影的安全性及有效性。方法 2012年1月至2013年3月行TRI的病例中,术前Allen试验阳性、Seldinger法穿刺桡动脉后穿刺套管回血满意但无法置入直导丝的21例患者,经套管将PTCA导丝送至锁骨下动脉处,置入6F桡动脉鞘管,经PTCA导丝推送5F造影导管至肱动脉,交换导丝完成冠状动脉造影。术后即刻拔除鞘管,观察术后即刻至术后3 d血管穿刺相关并发症(出血、血肿、迷走反射、假性动脉瘤)发生情况。结果 所有21例患者均成功应用PTCA导丝(Runthrough NS导丝)置入动脉鞘管,完成冠状动脉造影,12例(57.1%)患者随后完成经桡动脉PTCA及植入冠脉支架治疗,其中1例发生桡动脉痉挛。所有患者术后即刻造影显示无造影剂外渗,术后即刻至术后3 d内无穿刺点出血、前臂血肿、迷走反射及假性动脉瘤,术后监测血压良好。结论 桡动脉穿刺时穿刺针或套管回血满意、直导丝无法置入时,可应用PTCA导丝通过前臂血管成功置入动脉鞘管完成冠脉造影。该方法安全、有效,提高了桡动脉穿刺成功率,可作为桡动脉穿刺时的一种备选方法。 |
| 关键词: 经皮冠状动脉介入术 冠状血管造影术 桡动脉 并发症 |
| DOI： |
| 投稿时间：2013-05-31修订日期：2013-07-10 |
| 基金项目: |
|
| Application of percutaneous transluminal coronary angioplasty guidewire in introducing artery sheath and catheter during transradial intervention |
| ZHANG Zhi gang△,ZHANG Bi li△,LIU Yu,QIN Yong wen,ZHAO Xian xian* |
(Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To apply percutaneous transluminal coronary angioplasty (PTCA) guidewire (0.014 inch, 1 inch=2.54 cm) for introducing a sheath, and to assess its safety and efficacy in completing the transradial percutaneous coronary intervention (PCI). Methods Twenty-one patients were included in this study. They were scheduled to undergo elective coronary intervention via the radial artery from January 2012 to March 2013, with normal Allen’s test results, but the straight guidewire (0.025 inch) failed to be inserted through the needle after successful puncture of radial artery via Seldinger technique. Then a PTCA guidewire was used to gently access the radial artery instead of the straight guidewire to the brachial artery; the needle was removed and a 6F sheath was introduced into the radial artery over the PTCA guidewire, and the 5F coronary angiography catheter was advanced to the brachial artery, replacing the PTCA guidewire with a guidewire (0.035 inch) . Then the angiography was completed, and the artery sheath was removed immediately after PCI. The access site-related complications including hematomas, perforation, pseudoaneurysm, and vasovagal reaction were observed immediately after operation and for 3 days. Results The 6F sheath were advanced into the radial artery over the PTCA guidewire in all the 21 cases and coronary angiography were successfully completed. And coronary intervention was performed in twelve (57.1%) patients, with one patient having radial artery spasm. No extravasation of contrast media was noted immediately after operation; no vascular complications (access site bleeding, hematomas, pseudoaneurysm, and vasovagal reaction) were noted 3 days after operation; and the patients had a normal blood pressure after operation. Conclusion When the radial artery is successfully punctured and a straight guidewire (0.025 inch) failed to be inserted, PTCA guidewire can be used instead to deliver the sheath to complete PCI. The method is safe, effective, and can increase the success rate of puncture of the radial artery and therefore may be an alternative for radial artery puncture. |
| Key words: percutaneous coronary intervention coronary angiography radial atery complications |
