经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估  

Evaluation of acute and chronic radial artery injury after transradial coronary intervention

作　　者：牛丹[1] 华琦[2] 柳子静[1] 闫蕊 张利彬[1] 孙雨华[1] 王国忠[1] 张海滨[1] 郭金成[1] Niu Dan;Hua Qi;Liu Zijing;Yan Rui;Zhang Libin;Sun Yuhua;Wang Guozhong;Zhang Haibin;Guo Jincheng(Department of Cardiology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China;Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京101149 [2]首都医科大学宣武医院心内科,北京100054

出　　处：《首都医科大学学报》2019年第3期383-388,共6页Journal of Capital Medical University

基　　金：北京市通州区科技计划项目(KJ2018CX009)~~

摘　　要：目的应用光学相干断层成像(optical coherence tomography,OCT)评价经桡动脉冠状动脉介入术(transradial intervention,TRI)后桡动脉急慢性损伤。方法回顾性分析2017年5月至2018年4月行TRI及桡动脉OCT检查的患者114例。根据患者既往是否经同侧桡动脉行介入治疗分为首次TRI组(n=87)和重复TRI组(n=27)。TRI结束后将鞘管回撤至距穿刺点2 cm处并对桡动脉近段、中段和远段行OCT检查,比较两组患者桡动脉急性损伤(内膜撕裂、夹层、穿孔、血栓和痉挛)发生率及慢性损伤(内膜增生)。结果114例患者桡动脉内膜撕裂、夹层、穿孔、血栓及痉挛的发生率分别为31.6%、14.0%、1.8%、26.3%和50.0%。首次TRI组与重复TRI组患者急性损伤发生率差异无统计学意义(撕裂:28.7%vs 40.7%,P=0.680;夹层:13.8%vs 14.8%,P=0.782;穿孔:2.8%vs 0.0%,P=0.965;血栓:26.4%vs 25.9%,P=0.958;痉挛:51.7%vs 44.4%,P=0.509)。两组患者桡动脉各段急性损伤发生率差异均无统计学意义(P值均>0.05)。重复TRI组管腔狭窄率、内膜与中膜厚度比值和内膜厚度指数均明显高于首次TRI组(P值均<0.05)。结论重复TRI组与首次TRI组桡动脉急性损伤发生率差异无统计学意义;重复TRI组患者桡动脉内膜增生明显。Objective To evaluate acute and chronic effects of transradial intervention(TRI)on the radial artery(RA)with optical coherence tomography(OCT).Methods A total of 114 patients who underwent RA OCT examination after TRI during May 2017 to April 2018 were retrospectively enrolled in this study.The patients were divided into the first TRI group(n=87)and the repeat TRI group(n=27)based on whether the patients had experienced a homolateral TRI before.Immediately after TRI,the sheath was extracted 2 cm distal to the puncture site.The RA was examined with OCT and then divided into three parts:proximal,medial and distal.The acute injuries including intimal tear,dissection,perforation,thrombus and spasm as well as chronic injury like intimal hyperplasia of all segments of radial artery between the two groups were analyzed and compared.Results The incidence rate of intimal tear,dissection,perforation,thrombus and spasm was 31.6%,14.0%,1.8%,26.3%and 50.0%,respectively.There was no significant difference in the incidence of acute injury between the first TRI group and the repeat TRI group(tear:28.7%vs 40.7%,P=0.680;dissection:13.8%vs 14.8%,P=0.782;perforation:2.8%vs 0.0%,P=0.965;thrombus:26.4%vs 25.9%,P=0.958;spasm:51.7%vs 44.4%,P=0.509).As compared with the first TRI group,the intimal hyperplasia indexes like percentage of luminal narrowing(LN%),intima-media ratio(IMR)and intimal thickness index(ITI)were significantly higher in the repeat TRI group(P<0.05).Conclusion There was no significant difference between the repeat TRI group and the first TRI group in the incidence of acute injury.The intimal hyperplasia of RA was significant in repeat TRI group.

关 键 词：桡动脉 冠状动脉介入 光学相干断层成像 

分 类 号：R540[医药卫生—心血管疾病]