经桡动脉路径行CAG或PCI术中桡动脉血栓形成情况及其危险因素  

Radial artery thrombosis in optical coherence tomography guided transradial coronary angiography and percutaneous coronary intervention in acute coronary syndrome patients and its risk factors analysis

作　　者：柳子静[1] 牛丹[1] 李紫旋 郭金成[1] Liu Zijing;Niu Dan;Li Zixuan;Guo Jincheng(Department of Cardiology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院心血管内科,101149

出　　处：《中华心血管病杂志》2021年第1期37-42,共6页Chinese Journal of Cardiology

基　　金：首都卫生发展科研专项(2018-2-7082)。

摘　　要：目的应用光学相干断层成像(OCT)技术观察经桡动脉路径行冠状动脉造影(CAG)或经皮冠状动脉介入治疗(PCI)术中的桡动脉血栓形成(RAT)情况,并分析其危险因素。方法该研究为回顾性研究。选取2017年10月至2018年7月于首都医科大学附属北京潞河医院心脏中心经桡动脉路径行CAG或PCI的急性冠状动脉综合征患者,冠状动脉操作完成后行桡动脉OCT检查,观察RAT的发生情况,并据此分为RAT组及无RAT组。收集2组患者基本临床资料,根据OCT图像分析桡动脉血栓类型、分布以及桡动脉急性损伤情况,并采用单因素以及多因素回归分析RAT的危险因素。术后24 h及1个月时随访桡动脉闭塞发生率及患者术肢有无缺血症状。结果共入选107例患者,年龄(58.1±12.5)岁,其中男性84例(78.5%)。28例发生RAT,发生率为26.2%(95%CI 17.9%~34.5%),其中15例(53.6%)患者为白血栓,血栓最易形成的部位为桡动脉近段(17例,60.7%),血栓体积为0.05(0.03,0.38)mm^(3),血栓积分为6.5(3.3,13.8)。单因素分析结果显示RAT组桡动脉急性损伤、鞘管留置时间和比伐卢定使用比例高于无RAT组(P均<0.05)。多因素logistic回归结果显示,桡动脉急性损伤(OR=5.82,95%CI 2.09~16.20,P=0.001)及鞘管留置时间(OR=1.04,95%CI 1.01~1.06,P=0.006)是RAT的危险因素。术后24 h随访,RAT患者与无RAT患者术后桡动脉闭塞发生率差异无统计学意义[7.1%(2/28)比10.1%(8/79),P=1.000]。所有患者均无术肢手部严重缺血的临床症状。结论在经桡动脉行CAG或PCI术中,RAT是一种发生率较高的路径并发症。应用OCT技术可以准确观察RAT的发生,桡动脉的急性损伤及手术操作时间长可能会增加这种并发症的发生风险。Objective To observe the radial artery thrombosis(RAT)during transradial coronary angiography(CAG)and/or percutaneous coronary intervention(PCI)by optical coherence tomography(OCT),and to investigate the risk factors of RAT during the CAG and/or PCI.Methods In this retrospective study,we consecutively reviewed the radial artery OCT examination results of the patients who underwent OCT guided transradial CAG and/or PCI for acute coronary syndrome in heart center of Beijing Luhe hospital,Capital Medical University from October 2017 to July 2018.The incidence of RAT was observed.The patients were divided into the RAT group and non-RAT group,clinical data were collected and compared.Moreover,the types and distributions of thrombus in radial artery as well as the acute radial artery injuries under OCT were observed.Univariate analysis followed by multivariate analysis were performed to identify potential risk factors.The radial artery patency and ischemic symptoms of the involved limb were followed up at the 24-hour and the 1-month after procedure.Results A total of 107 patients were included,the age was(58.1±12.5),and 78.5%were male(n=84).The incidence of RAT was 26.2%(n=28,95%CI 17.9%-34.5%),and the main type of thrombus was white thrombus(n=15,53.6%).The commonest position of RAT was the proximal portion of radial artery(n=17,60.7%).The median thrombus volume was 0.05(0.03,0.38)mm^(3),and the median thrombus score was 6.5(3.3,13.8).In univariate analysis,the frequency of acute radial artery injury and use of bivalirudin were significantly higher and the procedure time was significantly longer in RAT group than those in non-RAT group(all P<0.05).Multivariate regression analysis showed that the radial artery acute injury(OR=5.82,95%CI:2.09-16.20,P=0.001)and the procedure time(OR=1.04,95%CI:1.01-1.06,P=0.006)were independent risk factors of RAT.Rate of radial artery occlusion at 24 hours follow-up was similar between RAT and non-RAT group(7.14%(2/28),vs.10.13%(8/79),P=1.000).None of the patients complicated severe is

关 键 词：经皮冠状动脉介入治疗 桡动脉 血栓形成 光学相干断层成像 

分 类 号：R541.4[医药卫生—心血管疾病]