经桡动脉冠状动脉腔内成形术及支架术51例临床经验  

Clinical experience of trans radial coronary angioplasty and stenting in 51 Chinese patients

作　　者：魏盟[1] 严卫[1] 樊冰[1] 王齐冰[1] 潘翠珍[1] 戎卫海[1] 何梅先[1] 蔡乃绳[1] 陈灏珠[1] 

机构地区：[1]上海医科大学中山医院,上海市心血管病研究所200032

出　　处：《中华心血管病杂志》1999年第6期450-452,共3页Chinese Journal of Cardiology

摘　　要：目的　评价经桡动脉冠状动脉腔内成形术的可行性。方法　我院自 1998年 7月至1999年 2月间共行经皮冠状动脉腔内成形术 (PTCA) 63例 ,其中 5 1例采用经桡动脉法完成PTCA ,男4 6例 ,女 5例 ,平均年龄 (60 0±9.6)岁。3 3例于术前及术后用彩色多普勒二维超声检测了右桡动脉的内径及平均血流速度。结果　术前桡动脉内径为 0 18～0 .3 7cm ,平均为 (0 2 6± 0 .0 4 )cm ,桡动脉血流速度为 2 3～ 98cm/s,平均为 (5 9± 18.5 )cm/s。术后桡动脉直径为 0 2 1～ 0 .3 9cm ,平均为 (0 2 5±0 .0 3 )cm ,桡动脉平均血流速度为 2 2 .4～10 0cm/s,平均 (5 6 9± 15 .5 )cm/s,术前与术后相比 ,桡动脉内径及平均血流速度之间差别无显著性 (P >0 .0 5 )。共对 71处病变实施了PTCA ,其中A型病变 3 0处 ,B型病变 17处 ,C型病变 2 4处 ;置入支架 5 1枚 ,其中A型病变 2 5处 ,B型病变 12处 ,C型病变 14处 ,最短支架为 9mm ,最长为 4 0mm ;最小直径为 2 .5mm ,最大为 4mm。所有病例均为冠状动脉造影后即刻行PTCA ,手术成功率为 92 .2 % (46/ 5 1) ,4例未成功 ,均为前降支完全闭塞 ,导丝未能通过病变。无一例转股动脉途径手术。并发症 1例 ,为欲对右冠脉中段行PTCA而指引导管进入过深造成近端血管严重夹层分离。Objective To evaluate the feasibility of trans radial coronary angioplasty and stenting.Methods 51 out of 63 patients were selected to undertake ad hoc trans radial coronary angioplasty. The average age of these patients was (60±9.5) years, 46 patients were male, 5 female. The right radial arteries were preferred to perform coronary angioplasty with Judkins technique. The inner diameters and average blood velocity of the right radial artery were measured with color Doppler echocardiography in 33 patients before and after coronary angioplasty.Results The diameters and the average blood velocities of the right radial artery did not change before and after coronary angioplasty (0.26±0.04 cm vs 0.25±0.03) cm and (55.9±18.5) cm/s vs (56.9±15.5) cm/s, respectively, all P >0.05). Balloon angioplasty was performed in 71 lesions (30 type A, 17 type B, and 24 type C). 51 stents were implanted in 51 lesions (25 type A,14 type B, and 12 type C). Among the 51 stents the shor test was 9 mm, the longest was 40 mm, the smallest in diameter was 2.5 mm, the biggest in diameter was 4 mm. Procedural success was achieved in 47 patients (92.2%). The procedure failed in 4 patients because guide wires could not pass through chronic oclusive lesions of LAD. Access related complications and occlusion of right radial arteries were not found during hospital stay. Only in one patient, the guiding catheter resulted in nonfatal non Q wave myocardial infarction. Conclusion Trans radial angioplasty and stenting are both feasible and safe with a low risk of access complications and with excellent procedural success.

关 键 词：血管成形术 支架术 PTCA 冠心病 

分 类 号：R541.405[医药卫生—心血管疾病] R654.2[医药卫生—内科学]