SAL指引导管在起源异常的右冠状动脉行经皮冠状动脉介入治疗中的应用  

Application of short Amplatz left guiding catheter in coronary intervention for patients with anomalous origin of right coronary arteries

作　　者：谢伟[1] 兰春虎[1] 袁争百 韩宏华[1] 苏振琪 陈大顺 

机构地区：[1]淮北矿工总医院心内科,安徽淮北235000

出　　处：《中国介入心脏病学杂志》2017年第1期31-34,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨SAL指引导管在起源异常的右冠状动脉行经皮冠状动脉介入治疗(PCI)中应用的安全性及有效性。方法回顾性分析2012年1月至2016年3月于淮北矿工总医院住院的22例右冠状动脉开口异常患者的介入诊疗资料。所有患者均常规采用经右侧桡动脉入径,选择JR或Tiger指引导管行右冠状动脉造影,若造影提示右冠状动脉开口异常并有PCI适应证,或经反复尝试造影导管无法到达右冠状动脉开口时,改用SAL指引导管造影。观察患者术中及术后血管痉挛、慢血流、无复流、开口撕裂、夹层、急性闭塞及主要不良心血管事件的发生情况。结果 22例患者中开口位于主动脉壁7例(31.8%)、左冠状窦7例(31.8%)、左回旋支2例(9.1%)及右冠状窦上方6例(27.3%)。10例(45.5%)患者经JR或Tiger指引导管完成冠状动脉造影,后有2例更换SAL指引导管完成PCI术;12例(54.5%)患者经JR或Tiger指引导管反复尝试均无法完成冠状动脉造影,更换SAL指引导管后11例造影成功,其中3例行PCI术。1例患者应用JR、Tiger及SAL指引导管反复尝试仍未能完成冠状动脉造影,后经冠状动脉CT血管造影证实开口于升主动脉侧壁。术中所有患者均未见血管痉挛、慢血流、无复流、开口撕裂、夹层、急性闭塞等并发症发生。术后随访6~12个月,未见心源性死亡、急性心肌梗死及靶血管再次血运重建等主要不良心血管事件发生。结论对于起源异常的右冠状动脉采用SAL指引导管行PCI,成功率高,且安全有效。Objective To explore the efficacy and safety of short Amplatz left （SAL） guiding catheter in percutaneous coronary intervention （PCI） to anomalous right coronary artery. Methods The data of percutaneous coronary intervention to anomalous right coronary artery of 22 patients from January 2012 to March 2016 were retrospectively reviewed. The anomalous origins included fight coronary artery originating from high aperture in 13 patients, from left coronary sinus in 7 patients and from left circumflex artery （LCX） in 2 patients. Routinely through the fight radial artery approach, JR or Tiger catheter were selected for coronary angiography. SAL guiding catheter was used when further intervention was indicated to the lesion and lither the JR or the Tiger cathers could not complete coronary angiography. Results Coronary angiography with JR or Tiger catheter was completed in 10 patients. With 2 patients required replacement of SAL guiding catheter to complete PCI. Coronary angiography were unable to complete in 12 patients with JR or Tiger catheters and among them, 11 patients had successful angiography by using the SAL catheter and 3 patients had completed PCI with the SAL guiding catheters. JR, Tiger and SAL guide catheter all failed in completing the coronary angiography in 1 patient who later was confirmed by coronary CTA to have fight coronary artery originating from the lateral well of ascending aorta. No coronary comlicatons including tear, dissection or acute occlusion were reorded. Conclusions Short Amplatz left （SAL） guiding catheter applied in percutaneous coronary intervention （PCI） for anomalous fight coronary artery is safe and efficient.

关 键 词：右冠状动脉起源异常 经皮冠状动脉介入治疗 SAL指引导管 

分 类 号：R541.4[医药卫生—心血管疾病]