经桡动脉途径采用6F指引导管行颈动脉支架成形术的可行性及安全性  

The feasibility and efficacy of transradial approach for carotid artery stenting using 6 F guiding catheter

作　　者：王子亮[1] 许岗勤[1] 汪勇锋[1] 李立[1] 梁晓东[1] 李天晓[1] 

机构地区：[1]郑州大学人民医院河南省人民医院介入科国家高级卒中中心,450003

出　　处：《中华放射学杂志》2016年第9期682-685,共4页Chinese Journal of Radiology

摘　　要：目的：探讨经桡动脉途径（TRA）使用6 F指引导管行颈动脉支架成形术（CAS）的可行性及安全性。方法回顾性分析28例采用TRA 6 F指引导管行CAS的颈动脉硬化狭窄患者资料，术前均评估经股动脉入路手术困难、不能耐受术后卧床或经股动脉手术失败。颈动脉硬化狭窄病变位于左侧9例、右侧19例。均经右侧桡动脉入路，6 F指引导管超选靶血管，植入远端保护装置，然后行球囊扩张及支架植入术。观察记录指引导管到位情况、支架植入成功率、桡动脉痉挛和穿刺点出血发生率，观察术后桡动脉搏动及闭塞情况、围手术期心脑血管事件发生情况，记录手术射线投射时间，并与同期经股动脉途径行CAS的30例患者的手术射线投射时间采用t检验比较。结果28例患者指引导管均到位，支架植入成功。TRA和经股动脉途径行CAS患者的手术射线投射时间分别（8.6±1.4）、（9.0±2.1）min，差异无统计学意义（t=－0.717，P=0.477）。穿刺后2例出现桡动脉痉挛，1例术后8 h出现穿刺部位出血。术后1周行桡动脉彩色超声检查，27例桡动脉通畅，1例血流减慢。3个月后复查可见所有患者桡动脉血流恢复通畅。无一例发生心脑血管事件。结论采用TRA 6 F指引导管行CAS安全、可行。Objective To explore the feasibility and safety of using 6 F guiding catheter to perform the carotid artery stenting （CAS） via transradial approach （TRA）. Methods A retrospective analysis of 28 cases with carotid atherosclerotic stenosis who were using 6 F guiding catheter to perform the CAS via TRA, and the preoperative assessment confirmed that some of whom were difficult to operate via femoral artery, or couldn＇t tolerate the lying in bed after the operation, and the others were failure to perform via femoral artery. The atherosclerotic carotid stenosis lesion of 9 cases were located in the left internal carotid artery （ICA）, and the other 19 cases were in the right ICA. All the patients were performed via the right radial artery approach, a 6 F guiding catheter was used to super-select the target vessel, implanted the distal protection device, then underwent balloon angioplasty and stent implantation. We observed and recorded that whether the guiding catheters were in the right places, the success rate of stent implantation, the incidence of radial artery spasm and the puncture site bleeding. The postoperative pulse and occlusion of radial artery, and the occurrence of cardio-cerebrovascular complications during perioperative period were also observed. The fluoroscopy time of surgery ray were also recorded, and compared with corresponding 30 cases who were performed CAS via the tranfemoral approach （TFA） by t test. Results The guiding catheters were in the right places and stenting success of all the 28 cases. There was no significant difference in the fluoroscopy time between TRA and TFA group [（8.6 ± 1.4） min vs. （9.0 ± 2.1） min,t=-0.717,P=0.477）]. Two cases appeared radial artery spasm after puncture, and 1 case experienced puncture site bleeding at 8 h after the operation. After examined the radial artery by color doppler ultrasound at 1 week after the operation, we＆amp;nbsp;found that blood flow of 27 cases were patency, but another 1 was slowed down, which was restored at

关 键 词：颈动脉狭窄 支架 桡动脉 放射学 介入性 

分 类 号：R651.1[医药卫生—外科学] R816.2[医药卫生—临床医学]