经远端桡动脉入路逆向开通闭塞桡动脉的临床效果评价  

Evaluation of clinical effectiveness of retrograde recanalization of occluded radial artery via distal transradial approach

作　　者：谢小菲 左生鑫 许金鹏 韩小亮 孙光成 李亮 XIE Xiao-fei;ZUO Sheng-xin;XU Jin-peng;HAN Xiao-liang;SUN Gang-cheng;LI Liang(Department of Cardiology,Anhui Chest Hospital,Hefei 230000,China)

机构地区：[1]安徽省胸科医院心血管内科,安徽合肥230000

出　　处：《中国介入心脏病学杂志》2025年第3期135-140,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨经远端桡动脉入路逆向开通闭塞桡动脉的临床效果。方法选取2022年12月至2024年4月在安徽省胸科医院心血管内科收治的拟行冠状动脉介入操作的桡动脉闭塞患者35例,且经远端桡动脉尝试开通闭塞桡动脉,主要观察目标为经远端桡动脉开通闭塞桡动脉的成功率,次要观察目标为经远端桡动脉开通桡动脉失败的影响因素、术后穿刺并发症以及桡动脉开通3个月后随访的通畅率。结果按照是否经远端桡动脉成功开通闭塞桡动脉分为成功组29例(82.9%)和失败组6例(17.1%)。失败组患者的吸烟(100.00%比17.24%,P=0.040)、糖尿病史(100.00%比10.34%,P=0.025)、慢性完全闭塞病变(83.33%比17.24%,P=0.030)比例均高于成功组,差异均有统计学意义;失败组球囊跟踪辅助技术应用比例(16.67%比58.62%,P=0.045)、术后3 d桡动脉直径[(1.63±0.13)mm比(2.13±0.32)mm,P=0.021)]和术后3 d桡动脉血流速度峰值[(0.10±0.78)m/s比(0.50±0.13)m/s,P<0.001)]均低于成功组,差异均有统计学意义。术后3 d的多因素Logistic回归分析显示,慢性完全闭塞病变为手术开通失败的独立危险因素(OR0.042,95%CI0.004~0.438,P=0.008)。成功组3个月后随访其通畅率为55.2%。结论经远端桡动脉逆向开通闭塞桡动脉具有安全可行性,但其远期通畅率不高,推荐不考虑通过其他路径进行冠状动脉介入的桡动脉闭塞患者使用此方法。Objective Radial artery occlusion(RAO) is one of the common complications following coronary intervention via the traditional radial artery approach.This study aims to evaluate the clinical effectiveness of retrograde recanalization of occluded radial arteries through the distal transradial approach(dTRA) approach.Methods A total of 35patients with RAO admitted to the cardiovascular department of the Anhui Chest hospital between December 2022 and April 2024,who were scheduled to undergo coronary intervention and had attempted recanalization of RAO via dTRA approach were selected.The primary result was the success rate of recanalizing RAO via dTRA.The secondary results included factors influencing the failure of recanalization via dTRA,postoperative puncture complications,and the patency rate at the 3-month follow-up.Results This study divided the patients into a successful group(29 cases,82.9%) and a failed group(6 cases,17.1%) based on whether the distal radial artery was successfully opened and occluded.The proportion of smoking(100.00% vs.17.24%,P=0.040),history of diabetes(100.00% vs.10.34%,P=0.025),and chronic total occlusion of coronary artery(83.33% vs.17.24%,P=0.030) in the failure group were higher than those in the success group,and the difference was statistically significant.The application rate of balloon tracking assisted technology in the failed group(16.67% vs.58.62%,P=0.045),and the diameter of the radial artery at 3 days after surgery [(1.63±0.13) mm vs.(2.13±0.32) mm,P=0.021]and the peak radial artery blood flow velocity at 3 days postoperatively [(0.10±0.78) m/s vs.(0.50±0.13) m/s,P<0.001] were all lower in the successful group,and the differences were statistically significant.Logistic regression analysis 3 days after surgery showed that chronic complete occlusion of the coronary artery was an independent risk factor for surgical opening failure(OR 0.042,95%CI 0.004-0.438,P=0.008).After 3 months of follow-up,the patency rate of the successful group was 55.2%.Conclusions Retrograde recanal

关 键 词：冠心病 经皮冠状动脉介入治疗 桡动脉闭塞 经远端桡动脉入路 逆向开通 

分 类 号：R541[医药卫生—心血管疾病]