经桡动脉急诊冠状动脉介入治疗的安全性与可行性

目的观察给急性心肌梗死(acute myocardial infarction,AMI)患者经桡动脉行急诊冠状动脉介入治疗(percutaneous coronary intervention,PCI)的安全性与可行性。方法选择2004年6月至2005年12月我院收治的289例临床诊断为AMI患者,发病均在12 h内。其中男性患者201例,女性患者88例,平均年龄(55.8±10.9)岁,分为经桡动脉介入(transradial coronary intervention,TRI)组142例与经股动脉介入(transfemoral coronary intervention,TFI)组147例。观察两组穿刺成功率、手术成功率、介入治疗时间、术后与穿刺相关并发症情况。结果TRI组142例患者,包括单支病变的患者82例,多支病变的患者60例,其中完全闭塞病变患者47例。TFI组147例患者,包括单支病变的患者85例,多支病变的患者62例,其中完全闭塞病变患者50例。两组病例基本特征比较差异无统计学意义。TRI组与TFI组手术穿刺成功率比较差异无统计学意义(98.6%比99.3%,P>0.05)。罪犯血管TIMI3级开通率,TRI组与TFI组比较差异无统计学意义(95.1%比93.9%,P>0.05)。从麻醉到第一次球囊扩张时间,TRI组为(29.1±6.2)min,TFI组为(27.5±7.0)min,P>0.05,从麻醉到指引导管撤出时间,TRI组为(47.3±16.0)min,TFI组为(43.0±17.1)min,P>0.05,两组比较差异无统计学意义。术后与穿刺相关的并发症,TRI组出现严重桡动脉痉挛3例,局部血肿2例。TFI组出现局部血肿7例,迷走反射12例,假性动脉瘤2例,排尿困难10例,腰痛5例。结论经桡动脉与经股动脉PCI治疗AMI同样具有较高的成功率,而术后与穿刺血管及其他因素相关的并发症的发生率,经桡动脉组却明显少于经股动脉组。因此桡动脉可作为给AMI患者行急诊PCI的常规途径之一。     

介入途径对冠状动脉介入术后焦虑和抑郁状态的影响

目的:研究经桡动脉或经股动脉冠状动脉介入治疗术后,患者焦虑抑郁状态的发生情况。方法:对99例因冠心病准备行经皮冠状动脉介入治疗(PCI)的患者根据采用路径分为两组:经桡动脉冠状动脉介入治疗(TRI,n=50)和经股动脉行冠状动脉介入治疗(TFI,n=49)。同时采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD),对两组患者术前及术后1d分别进行焦虑抑郁状态评分。HAMA8分定义为焦虑状态,HAMD8分定义为抑郁状态。结果:术前两组患者的HAMA和HAMD评分差异均无统计学意义[分别为(7.15±1.78)vs.(7.75±1.82),P=0.216]和[(6.80±1.75)vs.(6.78±2.15),P=0.763]。术后TRI组的HAMA平均评分:[(9.74±3.36)vs.(12.82±5.68),P=0.038]和HAMD的平均评分:[(9.94±3.37)vs.(13.02±3.75),P=0.022)]均显著低于TFI组。TRI组患者焦虑和抑郁状态的发生率显著低于TFI组[焦虑状态:18.0%vs.38.8%,P=0.022);抑郁状态:16.0%vs.34.7%,P=0.032]。多因素Logistic分析显示TFI和TRI相比是术后抑郁和焦虑状态的独立预测因素。结论:焦虑和抑郁状态均是PCI术后常见的情绪障碍,而TRI在对患者这两种情绪障碍的影响上均明显优于TFI。     

经桡动脉途径介入治疗老年患者冠状动脉分叉病变

目的通过对比桡动脉、股动脉途径PCI治疗老年患者冠状动脉分叉病变的成功率、手术即刻效果及患者的术后近中期预后情况,探讨经桡动脉(TRI)途径处理老年患者冠状动脉分叉病变的可行性和安全性。方法研究共入选135例接受PCI治疗的老年冠状动脉分叉病变患者,根据初始选择的介入途径分为TRI组(n=64)和经股动脉(TFI)组(n=71),对比两组患者接受PCI治疗的成功率、造影剂用量、手术时间、并发症的发生率及再狭窄的发生率。结果TRI组64例中63例成功使用经桡动脉动脉,1例由于桡动脉严重痉挛并入股动脉组。PCI成功率TRI组为98.4%,TFI组为100%。PCI术中,TRI组84.1%的患者选用的是6F导引导管,而TFI组76.4%患者选用的是7F导引导管。术后TRI组仅1例患者出现血管并发症,而TFI组患者中有5例患者出现了血管并发症。TRI组和TFI组患者在PCI术后9个月时严重心脏不良事件的发生率(14.3%比15.3%)、支架血栓事件(1/6比1/71)及随访期造影提示主、边支界定再狭窄率(10.9%比10.0%,17.4%比22.0%)差异无统计学意义。结论经桡动脉途径PCI治疗老年患者分叉病变具有良好的可行性和安全性,有利于降低血管并发症的发生率。     

经桡动脉与经股动脉介入治疗急性心肌梗死的对比研究

目的：探讨对急性心肌梗死患者经桡动脉途径行急诊介入治疗的有效性和可行性。方法：回顾性分析急诊介入治疗ST段抬高心肌梗死62例,对比经桡动脉介入（TRI,38例）及经股动脉介入（TFI,24例）穿刺成功率及经皮冠状动脉介入治疗（PCI）成功率、血管穿刺时间及手术时间、出血及穿刺相关并发症。结果：血管穿刺成功率：TRI组为97.4%,TFI组为100%,PCI成功率分别为94.7%和95.8%（P〉0.05）,均无明显差异。两组血管穿刺时间无显著差异（P〉0.05）。TRI组总PCI时间明显短于TFI组[（38.56±11.55）min比（43.77±10.62）min,P〈0.05];穿刺相关并发症发生率明显低于TFI组（5.26%比16.67%,P〈0.01）。结论：经桡动脉途径急诊介入治疗急性心肌梗死安全有效,不逊于经股动脉途径,对于选择性手术可以优先选用。     

经桡动脉途径介入治疗急性心肌梗死临床分析

目的 评价急性心肌梗死患者经皮桡动脉介入治疗(PCI)的安全性和有效性.方法 共入选91例急性心肌梗死患者,经桡动脉介入治疗组(TRD)59例,经股动脉介入治疗组(TFD)32例.观察穿刺成功率、手术成功率、手术时间、透视时间、造影剂用量及穿刺并发症.结果 两组穿刺成功率、手术成功率、手术时间、透视时间、造影剂用量差异均无统计学意义(P＞0.05),TRI组穿刺并发症明显低于TFI组(P＜0.05).结论 急性心肌梗死行PCI时,经桡动脉途径同样安全、有效,手术结果相似而并发症明显减少.     

经桡动脉介入治疗冠心病的住院期间疗效和主要不良心脏事件的预测因素

目的 评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素.方法 入选阜外心血管病医院2004年5月至2009年5月16 281例经桡动脉介入治疗冠心病患者(桡动脉组)和5388例经股动脉介入治疗冠心病患者(股动脉组).比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效,并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件(包括死亡、心肌梗死和靶病变血运重建)的预测因素.结果 与股动脉组比较,桡动脉组冠状动脉导管插入时间较长(P＜0.01),X线曝光时间、对比剂用量差异无统计学意义.桡动脉组与股动脉组操作成功率差异无统计学意义(95.5%比96.2%,P＞0.05).血管径路并发症比例桡动脉组低于股动脉组(0.1%比1.3%,P＜0.01).桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组(分别为1.6%比3.8%,P＜0.01;0.2%比0.4%,P＜0.01).多因素logistic回归分析表明,经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁(OR:1.98,95%可信区间:1.50～2.61,P＜0.01)、既往心肌梗死(OR:2.14,95%可信区间:1.63～2.82,P＜0.01)、置入药物洗脱支架(OR:0.68,95%可信区间:0.47～0.98,P=0.04)、冠状动脉夹层(OR:4.08,95%可信区间:2.28～7.33,P＜0.01)、左主干病变(OR:2.12,95%可信区间:1.09～4.13,P=0.03)、支架数(OR:1.25,95%可信区间:1.09～1.43,P＜0.01)、支架总长度(OR:1.01,95%可信区间:1.00～1.02,P=0.03).结论 经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性.年龄≥65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素.

Abstract：

Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of chinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events ( composite of death, myocardial infarction,or target lesion revascularization) of TRI. Results The annulations time was significantly longer for TRIthan TFI (P ＜0. 01 ), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96. 2% for TFI) were similar between the two groups. However, the rates of vascular complications (0. 1% for TRI group and 1.3% for TFI group, P ＜0. 01 ), incidence of in-hospital major adverse cardiac events (1.6% vs. 3. 8%, P＜ 0.01) and in-hospital death (0.2% vs. 0.4%, P＜0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥65 ( OR: 1.98,95% CI: 1. 50 - 2. 61, P ＜ 0. 01 ), prior myocardial infarction ( OR:2. 14, 95% CI: 1.63 - 2. 82, P ＜0. 01 ), use of drug-eluting stent (DES) ( OR:0. 68, 95% CI:0. 47 - 0. 98, P = 0. 04 ), dissection during procedure (OR:4.08, 95%CI:2.28-7.33, P＜0.01), left main lesion (OR:2. 12, 95% CI:1.09-4. 13, P=0.03), number of implanted stents (OR:1.25, 95% CI:1.09 - 1.43, P ＜0.01), and total stented length (OR:1.01, 95% CI:1. 00 -1. 02 , P=0.03). Conclusions In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.     

经桡动脉介入治疗无保护左主干病变的可行性与安全性研究

目的探讨经桡动脉行无保护左主干病变介入治疗的可行性和安全性。方法回顾性分析92例行介入治疗的无保护左主干病变患者,其中经桡动脉途径49例,经股动脉途径43例,观察两组患者的临床特征、病变特点、器械选择、并发症及主要心脏不良事件(MACE)。结果临床特征、复杂分叉病变、手术成功率两组之间差异无统计学意义(均为P0.05);支架直径、长度,支架释放压力与最大扩张压力两组之间差异无统计学意义(均为P0.05)。手术时间、投照时间、造影剂用量两组之间差异无统计学意义(均为P0.05)。桡动脉组与股动脉组比较,术后住院时间较短[(2.2±0.4)d比(3.3±0.5)d](P0.01)、局部血管并发症较少[2.0%(1/49)比14.0%(6/43),P0.05]。12个月的随访期间两组MACE率相似[8.2%(4/49)比7.0%(3/43),P=0.83]。结论经桡动脉行无保护左主干病变介入治疗缩短了住院时间,减少了外周血管并发症,具有良好的可行性与安全性。     

经皮桡动脉冠脉介入治疗急性心肌梗死的临床研究

目的 探讨经皮桡动脉入路冠脉介入治疗急性心肌梗死的临床应用及预后随访.方法 收集2008年7月至2014年5月苏州市立医院确诊的急性心肌梗死患者179例,其中经皮桡动脉入路介入治疗107例（TRI组）,经皮股动脉入路介入治疗72例（TFI组）.观察两组的穿刺成功率、PCI成功率、手术总时间、穿刺点并发症情况,以及随访3个月预后情况.结果 TRI组107例患者中,前壁心梗47例,下壁心梗39例,其他21例;单支病变24例,双支病变34例,三支病变49例.TFI组72例患者中,前壁心梗27例,下壁心梗29例,其他16例;单支病变12例,双支病变20例,三支病变40例.TRI组和TFI组穿刺成功率分别为97.2％和100％,P=0.401;PCI成功率分别为89.7％和95.8％,P=0.135;手术总时间分别为（79.4±32.0）min和（78.8±33.3）min,P=0.911.术后3个月的随访临床结果显示,MACE事件发生率TRI组较TFI组低.结论 经皮桡动脉直接冠脉介入治疗急性心肌梗死同经皮股动脉一样有着较高的手术成功率,且并发症较少,是急性心肌梗死介入治疗的最佳入路途径.     

经桡、股动脉介入治疗慢性左心衰竭冠心病的疗效对比

目的 分析经桡动脉介入(TRI)、股动脉介入(TFI)治疗慢性左心衰竭的老年冠心病患者的临床效果.方法 左心衰老年冠心病患者共163例,根据采用介入治疗的方法不同分为TRI组70例,TFI组93例.结果 所有患者平均手术时间为(66.95±24.26) min,两组患者平均术后卧床时间为(13.45±9.13)h,TFI组术后卧床时间明显高于TRI组(P＜0.05);163例患者中术后并发症总发生率为14.72％,TFI组发生率明显高于TRI组(P ＜0.05);163例患者中总复发率为13.5％,TFI组复发率明显高于TRI组(P＜0.05).复发多因素Logistic回归分析显示:组别与手术时间与复发存在明显相关性(P＜0.05).结论 TRI治疗慢性左心衰竭的老年冠心病患者有术后卧床时间短,并发症少,复发率低的优点.     

经股动脉与桡动脉两种路径介入治疗冠心病的安全性与有效性对比分析

目的：比较经股动脉与桡动脉两种路径介入治疗（PCI）冠心病的疗效和安全性。方法采用双盲法将拟在我院行 PC I治疗的冠心病患者210例随机分为两组,分别行经股动脉 PC I治疗（对照组）和经桡动脉 PC I治疗（观察组）。观察两组手术情况、术后疗效及并发症发生情况。结果观察组穿刺时间、X线曝光时间、手术操作时间及造影剂使用量分别为5.09 min±1．12 min、9.22 min±1.29 min、49．54 min±7.11 m in、88.70 mL±11.06 mL ,与对照组比较差异无统计学意义（P＞0.05）,而加压包扎时间5．71 min±0．58 min,显著短于对照组的10．53 min±0．94 min（P＜0.05）;观察组一次性穿刺成功率和 PC I成功率为98.09％和99.05％,与对照组比较差异无统计学意义（P＞0.05）,而术后卧床时间和平均住院天数分别为5.28 min±2．91 min和6.24 d±0.69 d,显著短于对照组（P＜0.05）;观察组总不良反应发生率为5．71％,显著低于对照组的20.95％（P＜0.05）。结论经股动脉与桡动脉介入治疗冠心病均具有较高成功率,桡动脉介入治疗并发症率更低、卧床时间更短,可以作为首选路径。     

Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial.

Transradial coronary intervention (TRI) can be performed in elective patients with low incidence of access site complications. However, the feasibility of primary stent implantation by TRI is still not clear in patients with acute myocardial infarction (AMI). We prospectively randomized 149 patients out of 213 patients with AMI within 12 hr from onset into two groups: 77 patients treated by TRI (TRI group) and 72 patients by transfemoral coronary intervention (TFI; TFI group). We compared the incidences of major adverse cardiac events (MACE; repeat MI, target lesion revascularization, and cardiac death) during the initial hospitalization and 9-month follow-up periods in both groups. There were one patient who crossed over to the opposite arm, and two patients with severe bleeding complications in the TFI group. Background characteristics of patients were similar between the two groups. The success rate of reperfusion and the incidence of in-hospital MACE were similar in both groups (96.1% and 5.2% vs. 97.1% and 8.3% in TRI and TFI groups, respectively). In selected patients with AMI, primary stent implantation by TRI is feasible as compared to TFI.     

Treatment of saphenous vein graft lesions with drug-eluting stents: immediate and midterm outcome

OBJECTIVES: The purpose of the present report was to evaluate clinical and angiographic outcomes of drug-eluting stent (DES) implantation in saphenous vein graft (SVG) lesions. BACKGROUND: The safety and efficacy of DES implantation for the treatment SVG lesions remains uncertain. METHODS: We evaluated in-hospital and six-month outcomes in 61 consecutive patients treated with DES in SVG lesions from March 2002 to March 2004 (DES group), as compared to 89 consecutive patients treated with bare-metal stents (BMS) in the 24 months immediately before the introduction of DES (BMS group). Major adverse cardiac events (MACE) including death, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and at six-month follow-up. RESULTS: The rate of in-hospital MACE was similar between the two groups (6.6% vs. 5.6%, p = 1.0). Cumulative MACE at six months was 11.5% in the DES group and 28.1% in the BMS group (p = 0.02). The DES group had a significantly lower incidence of in-segment restenosis (10.0% vs. 26.7%, p = 0.03), TLR (3.3% vs. 19.8%, p = 0.003), and TVR (4.9% vs. 23.1%, p = 0.003). By Cox regression analysis, diabetes (hazard ratio [HR]: 3.03; 95% confidence interval [CI]: 1.33 to 6.90; p = 0.008), usage of BMS (HR: 2.53; 95% CI: 1.07 to 5.97; p = 0.03), and age of SVG (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02) were identified as predictors of MACE at six-month follow-up. CONCLUSIONS: Compared to BMS implantation, DES implantation in SVG lesions appears safe with favorable and improved mid-term outcomes.     

自噬相关基因5下调抑制静脉桥血管狭窄

目的探讨自噬相关基因5(Atg5)在小鼠下腔静脉移植术后静脉桥血管狭窄过程中的作用。方法30只雄性C57BL/6小鼠及20只Atg5^+/-小鼠分为WT假手术组(10只),WT手术组(受体10只,供体10只),Atg5^+/-手术组(受体10只,供体10只)。复制小鼠下腔静脉移植模型。HE染色观察下腔静脉管腔面积,Real-time PCR检测下腔静脉组织中Atg5、LC3 mRNA表达;Westem-Blot检测下腔静脉组织中Atg5、LC3蛋白表达,免疫荧光共染明确平滑肌细胞中LC3表达。结果WT小鼠下腔静脉移植4周后出现管腔狭窄[(4.21±0.32)×10^4μm^2比(1.63±0.15)×10^4μum^2,P<0.05],Atg5[(0.51±0.17)×10^-3比(1.49±0.08)×10^-3]、LC3[(1.9±0.4)×10^-2比(3.8±0.9)×10^-2]mRNA表达均明显升高(均为P<0.05)。与WT小鼠相比,Atg5^+/-小鼠下腔静脉移植4周后Atg5[(0.39±0.05)比(0.16±0.08)]、LC3[(2.17±0.46)比(0.78±0.19)]蛋白表达均明显下降(均为P<0.05),平滑肌细胞中LC3蛋白表达显著下降(P<0.05),管腔狭窄明显减轻[(1.63±0.15)×10^4μm^2比(2.96±0.12)×10^4μm^2,P<0.05]。结论Atg5下调抑制小鼠下腔静脉移植术后静脉桥血管狭窄。     

经桡动脉行冠状动脉介入治疗在老年冠心病患者中的应用

目的探讨老年冠心病患者经桡动脉行PCI的可行性和安全性。方泼选择709例老年(年龄≥75岁)冠心病患者,根据患者接受PCI的入路途径不同,分为桡动脉组(227例)和股动脉组(482例),比较两组患者临床基线PCI的成功率、造影剂用量、手术时间、并发症的发生率以及术后6个月时发生严重心脏不良事件的情况。结果桡动脉组血脂异常患者的比例高于股动脉组(P<0.05)。桡动脉组手术成功率为97.8%,股动脉组患者全部成功接受PCI。两组手术时间和造影剂用量比较,差异无统计学意义,桡动脉组3例(1.3%)患者出现血管并发症,股动脉组27例(5.6%)出现并发症,两组比较差异有统计学意义(P<0.05),桡动脉组和股动脉组患者术后6个月时严重心脏不良事件的发生率比较,差异无统计学意义(8.4% vs 7.3%,P>0.05)。结论老年冠心病患者经桡动脉行PCI具有良好的可行性和安全性。     

Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST elevation myocardial infarction

Background: Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients. Methods: This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis. Results: TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 ? 119.5) versus 98 (IQR 80.8 ? 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 ? 45.0) versus 37 (IQR 28.0 ? 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups. Conclusion: In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI. (J Interven Cardiol 2012;25:235–244)     

ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗时应用单根指引导管的有效性与安全性

目的评估急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经桡动脉途径行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中依据术前检查结果,直接使用单根指引导管的有效性与安全性。方法连续入选2017年1月至2019年1月于汕头市第二人民医院住院,诊断为STEMI且具有急诊冠状动脉造影及PCI治疗指征的患者120例。用随机数字表法以1∶1随机分为试验组与对照组。对比两组门-球囊(door-to-balloon,D2B)时间、穿刺至球囊时间、住院时间及半年主要不良心血管事件(major adverse cardiac event,MACE)发生率等。结果试验组中的D2B时间[(65±15)min vs.(73±19)min,P=0.01]和穿刺至球囊时间[(18±10)min vs.(28±13)min,P<0.001]比对照组更短,差异有统计学意义。在试验组中,使用指引导管的数量显著低于对照组,差异有统计学意义(P<0.05)。30 d随访过程中,两组均有2例MACE发生,两组MACE发生率比较,差异无统计学意义(P>0.05)。结论依据术前检查的结果,直接使用单个指引导管在STEMI患者中行急诊PCI治疗能有效缩减D2B时间。