应用5F引导导管经桡动脉冠状动脉内直接支架置入术  

Use of 5 French Guiding Catheters in Trans-Radial Direct Coronary Stenting

作　　者：田军[1] 赵全明[2] Gille Grollier 

机构地区：[1]河南省人民医院二内科,河南省郑州市450003 [2]首都医科大学北京安贞医院心内科 [3]法国冈城大学医疗中心心内科

出　　处：《中国循环杂志》2003年第3期195-198,共4页Chinese Circulation Journal

摘　　要：目的 :评价应用 5F引导导管经桡动脉冠状动脉内直接支架置入术的可行性、安全性 ,探讨其应用策略。　　方法 :应用 5F引导导管对 14 1例患者的 177处冠状动脉病变和 2处静脉旁路血管病变进行直接支架置入治疗。在10 7例患者的 12 9处左冠状动脉病变中有 71例应用Judkins左冠导管 ,19例应用EBU导管 ,17例应用Amplatz左冠导管。在 48例右冠状动脉病变中有 3 2例应用Judkins右冠导管 ,11例应用Amplatz左冠导管 ,5例应用Amplatz右冠导管。2例静脉旁路血管病变均应用Judkins右冠导管。　　结果 :14 1例患者 179处病变血管中 174处 (97 2 % )直接支架置入成功 ,支架直径 2 5～ 4 0mm ,长度 8～ 3 3mm ;5处 (2 8% )病变支架置入未成功 ,仅行经皮冠状动脉腔内成形术。 14 1例患者病变血管平均狭窄程度治疗前为 (86 3±6 8) % ,治疗后为 (5 6± 2 6) %。仅有 1例 (0 7% )出现桡动脉闭塞 ,但并未影响手部供血。　　结论 :应用 5F引导导管经桡动脉进行冠状动脉内直接支架置入术具有可行性和较高的安全性 ;但需掌握导管的选择 ,以增加导管的后坐力和同轴性 ,提高成功率 ;严格筛选合适的靶病变是成功的重要前提。Objective: To evaluate the feasibility and safety of 5 French guiding catheters in trans-radial direct coronary stenting and to explore the strategy for choice of guiding catheter curves. Methods: ①Subjects: A consecutive series of 141 patients with coronary disease were included. Among them, there were 109 of one vessel disease, 22 of double vessels diseases, 8 of three vessels diseases, 2 of saphenous vein grafts disease, total 179 lesions. ②Choice of guiding catheters: Medtronic AVE 5F Z 2 guiding catheters were used in this study. Left Judkins catheter was used in 71 cases (66.3%), EBU catheter in 19 (17.8%) and left Amplatz catheter in 17 (15.9%) for 129 left coronary lesions in 107 patients. Right Judkins catheters in 32 cases (66.7%), left Amplatz catheter in 11 (22.9%) and right Amplatz catheter in 5 (10.4%) for 48 right coronary lesions. Right Judkins catheters in 2 cases of saphenous vein grafts were used. Results:One hundred and seventy-nine lesions were treated. 174 lesions (97.2%) were directly stented, and 5 lesions (2.8%) were only dilated with balloon because of failure of stenting. A total of 174 stents were implanted, with diameters ranging from 2.5 mm to 4 mm and lengths from 8 mm to 33 mm. Average stenosis rate was (86.3±6.8)% before stenting and (5.6±2.6)% after stenting. The complication of vascular access site occurred only in one patient (0.7%), which was occlusion of arterial radial but without hand ischemia. Conclusions: Using 5 French guiding catheters in trans-radial direct coronary stenting were both feasible and safe with a very low risk of coronary and access site complications. However it is necessary to have a good knowledge of strategy for selecting of guiding catheters curves in order to obtain an easier and safer operation. Well-screening the target lesions is very important for success.

关 键 词：冠状动脉内直接支架置入术 经桡动脉 5F引导导管 可行性 安全性 冠状动脉病变 

分 类 号：R543.3[医药卫生—心血管疾病]