经桡动脉入路行冠状动脉造影及介入诊疗1932例

经桡动脉冠脉介入诊断治疗具有创伤小、恢复快、费用低等特点,其优越性已被越来越多的医师所认识并被患者所接受。但是经桡动脉行冠状动脉造影和经皮冠状动脉介入治疗（Percutanious coronary interventions,PCI）对术者的技巧和经验有较高要求。我院2005年7月～2009年4月对1932例患者行经桡动脉人路冠脉造影和PCI。     

经皮桡动脉入路在急性心肌梗死直接冠脉介入治疗中的疗效观察

目的 探讨经皮桡动脉入路直接介入治疗急性心肌梗死的疗效.方法 对46例行经皮桡动脉入路直接冠状动脉介入(PCI)治疗的急性心肌梗死患者(A组)进行回顾性分析,对照组为48例行经皮股动脉入路直接PCI治疗的急性心肌梗死患者(B组),随访术后6个月内冠状动脉急性及亚急性血栓形成、再狭窄、心血管事件的发生率及6个月冠状动脉造影复诊率.结果 94例患者PCI治疗均成功.介入治疗1个月后随访结果显示,两组均没有发生冠状动脉内血栓形成(P＞0.05),介入治疗6个月后随访结果 显示,再狭窄及心血管事件发生率均无统计学差异(P＞0.05).6个月冠状动脉造影复诊率A组明显高于B组(P＜0.05).结论 急诊行经皮桡动脉入路介入治疗急性心肌梗死是安全可行的,不增加近期血栓形成和心血管事件的发生率,而且能提高冠状动脉造影复诊率.     

左桡动脉远端入路冠状动脉介入诊疗术的安全性和可靠性北大核心CSCD

目的评估经左桡动脉远端穿刺行冠状动脉介入诊疗术的安全性和可靠性。方法选取2019年1月至2020年1月于大连大学附属中山医院接受冠状动脉造影和经皮冠状动脉介入治疗(PCI)的550例患者为研究对象,其中260例行右桡动脉穿刺,290例行左桡动脉远端穿刺,穿刺成功者分别入组A组、B组。观察两组介入穿刺置管时X线曝光时间、造影使用导管数、完成靶血管重建数、PCI复杂程度以及术后前臂出血、桡动脉并发症等。结果248例(95.4%)患者顺利完成右桡动脉穿刺冠脉诊疗术(A组),277例(95.5%)顺利完成经左桡动脉远端冠脉诊疗术(B组),差异无统计学意义(P>0.05)。两组X线曝光时间、造影使用导管数、完成靶血管重建数、PCI复杂程度差异无统计学意义(均P>0.05)。但B组围术期前臂出血、桡动脉闭塞发生率远小于A组(P<0.01,P=0.036)。结论经左桡动脉远端途径行冠状动脉诊疗术安全可靠,提高了术者和患者舒适性。     

彩超探查经桡动脉冠状动脉造影入路的应用价值

目的：评价彩超探查经桡动脉途径冠状动脉造影（ transradial coronary angiography , TRA ）入路的应用价值。方法择期行经桡动脉冠状动脉造影患者400例,随机分为术前彩色多普勒超声检查组（实验组）和非多普勒超声检查组（对照组）,各200例。主要评价指标包括造影成功率、造影时间、不同直径造影鞘管使用率、术中及术后不良事件（如死亡、急性心肌梗死、局部血肿、假性动脉瘤、骨筋膜室综合征和桡动脉闭塞）;次要评价指标包括桡动脉内径、超声下入路解剖变异发生率。结果实验组造影成功率（100％）较对照组（90％）高,但差异无统计学意义（P＞0．05）。实验组造影时间比对照组缩短[（10．7±1．0）min vs （12．5±3．5）min,P＜0．05]。实验组血管并发症发生率显著低于对照组;两组均未发生死亡、假性动脉瘤、桡动脉闭塞及骨筋膜室综合征。结论 TRA前应用彩超探查造影入路可提高造影成功率,缩短造影时间,减少术中桡动脉痉挛及术后局部并发症。     

经桡动脉入路外周介入中国专家共识

经桡动脉入路（transradial access,TRA）行介入手术具有安全、舒适的特点,是冠脉介入的首选入路。但TRA在外周介入中应用不足。目前对如何选择合适的患者、合适的器械、降低TRA并发症及提高TRA使用率尚认识不足。为了更好地推广TRA在外周介入中的应用,指导TRA临床患者选择、技术操作规范和医师技能训练,中国抗癌协会肿瘤介入学专业委员会于2022年组织全国范围内的介入专家成立《经桡动脉入路外周介入中国专家共识》工作小组,并共同制定本共识。本文主要聚焦TRA外周应用现状、优势及局限性、桡动脉解剖学特征、患者选择、操作规范、常见并发症预防与处理、辐射剂量及学习曲线,并通过文献评价结合专家组意见达成共识。     

经左侧远桡动脉入路在肝动脉化疗栓塞术中的应用

目的评估采用经左侧远桡动脉行肝动脉化疗栓塞术（TACE）的可行性及安全性。 方法回顾性收集我中心2020年10月至2021年7月经左侧远桡动脉行TACE的患者15例,对穿刺成功率、置鞘成功率、穿刺点渗血或血肿、动脉夹层、动脉闭塞等并发症发生率进行统计。 结果15例患者均穿刺成功,14例患者穿刺后成功置入鞘管,置鞘成功率93.3%,1例患者由于动脉痉挛,导丝无法通过血管最终转为股动脉入路手术。术后1例患者发生穿刺点渗血,未见动脉夹层或闭塞等并发症。 结论初步经验显示经远桡动脉入路行TACE是安全可行的,未来还需大样本病例证实。     

桡动脉与股动脉入路模拟冠脉造影术患者和术者辐射剂量比较

 目的 比较经桡动脉与经股动脉途径行冠脉造影术中患者及术者的辐射剂量。方法 采用同一拟人体模模拟临床条件下的冠脉造影。根据不同造影入路(均为右侧入路),实验分为经股动脉行冠脉造影组(transfemoral intervention ,TFI)和经桡动脉行冠脉造影组(transradial intervention,TRI),根据不同测量位置和不同辐射防护措施,TFI组进一步分为TFI1-TFI4四个亚组,TRI组进一步分为TRI1-TRI8八个亚组。使用皮肤辐射剂量仪和造影机随机配备的射线剂量仪(DAP和AK)分别记录术者和患者的辐射剂量,使用机器预设程序自动调节造影体位并控制透视及造影时间,每组数据重复测量10次取均值进行比较。结果 TRI组总剂量均值、透视累计剂量均值、造影累计剂量均值较TFI组均明显增加。造影过程7个体位中,DAP、AK值最大的三个体位均为左前斜体位。经桡动脉操作时,使用桡动脉专用护具的各亚组,其术者的辐射剂量均明显低于未使用护具的亚组。结论 与TFI相比,TRI时术者手部、胸部辐射剂量明显高于前者,而胸部辐射剂量的差异在左前斜体位时最为显著,其他体位并不明显;无论何种入路行冠脉造影,患者辐射剂量在左前斜体位时最高。因此术者在操作过程中应该合理使用造影体位,减少不必要的辐射。桡动脉专用护具配合常规防护设备共同使用可以大大减少经桡动脉操作时术者辐射剂量,值得推广。     

单侧与双侧入路行椎体后凸成形术的效果比较

目的对比单侧入路与双侧入路行经皮球囊扩张椎体后凸成形术(PKP)治疗胸腰椎骨质疏松性骨折的疗效。方法回顾性统计北京水利医院2011年6月～2015年10月收治的69例胸腰椎骨质疏松性骨折,其中男性19例,女性50例,年龄52～91岁,平均66.7岁。采用单侧入路或双侧入路行PKP治疗,记录骨水泥用量、手术时间、VAS评分、Cobb角变化度、椎体高度压缩率、恢复率等指标,术后随访时间1个月。结果单侧入路组的手术时间为(28.6±6.4)min,显著优于双侧入路组的(40.1±9.6)min(P0.05)。两组的骨水泥用量分别为(4.2±1.7)m L和(4.5±2.0)m L无统计学差异(P0.05)。两组的术前Cobb角分别为(19.5±7.9)°和(21.1±9.1)°,术后分别为(11.6±5.5)°和(12.2±5.8)°,两组术后Cobb角均较术前有明显改善(P0.05),但两组间无显著统计学差异。两组术前椎体高度压缩率分别为(31.7±11.6)%和(34.2±15.1)%,术后分别为(12.4±5.7)%和(12.8±4.9)%,术后椎体高度较术前均有明显恢复(P0.05),恢复率分别为(60.9±20.1)%和(62.6±22.4)%,两组间无显著统计学差异。两组VAS评分,术前分别为(7.65±1.91)和(7.82±1.75),术后即刻分别为(3.88±1.12)和(4.03±1.02),术后1d分别为(2.36±0.49)和(2.34±0.53),术后3d分别为(1.48±0.33)和(1.41±0.41),术后1月分别为(0.12±0.05)和(0.19±0.06)。术后较术前疼痛均有明显缓解(P0.05),但两组间无显著统计学差异。结论单、双侧入路椎体后凸成形术治疗胸腰椎骨质疏松性骨折,均能达到满意疗效,若采用C型臂X线机透视,单侧入路手术时间更短。     

经桡动脉冠脉介入520例诊治体会

目的:探讨经桡动脉冠脉介入的安全性,防范严重并发症的发生。方法:回顾分析520例经桡动脉冠脉介入患者资料。结果:未完成冠脉造影1例,未完成冠脉介入1例。桡动脉痉挛126例,死亡1例,室颤3例。结论:经桡动脉途径行冠状动脉介入治疗不需卧床,患者损伤小,止血方便,严重血管并发症少。     

经挠动脉途径行冠状动脉造影术126例分析

目的:探讨经桡动脉途径行经皮冠状动脉造影术的特点和安全性。方法:选择126例经桡动脉径路冠状动脉造影患者观察其手术成功率、并发症等。结果:桡动脉径路成功率87.3%,术后桡动脉闭塞1例,局部血肿1例,渗血2例。结论:经桡动脉途径行经皮冠状动脉造影术手术并发症少、痛苦小以及术后无需制动等优点,是开展冠状动脉造影术的理想方法。     

Accuracy of quantitative coronary angiography for different directions of the coronary artery

We evaluated the effect of changes in the direction of the coronary artery in terms of the accuracy and precision of vessel diameter measurement in a quantitative coronary angiography system (QCA system). Vessel phantoms sized 0.3, 0.5, 1.0, 1.5, 2.0, and 2.5 mm in diameter were evaluated. The phantoms were aligned on an acrylic plate, and the angle to the television (TV) camera was altered. The deployed angles were 0 (perpendicular), 45, 90, and 135 degrees in clockwise order. The phantoms were imaged with matrices of 1024 x 1024 (1024(2)), 512 x 512 (512(2)), and 512 x 1024. Image size was 7 inches, and the frame rate was 15 frames per second. Minimal lumen diameters were measured on the ACA system. The results revealed that, in the 1024(2) matrix, overall accuracy for the 90-degree angle was significantly underestimated compared with the 0-degree angle (-0.14 vs. -0.014 mm; p=0.007). Accuracy for the 90-degree angle was better than that for the 0-degree angle when the vessel diameter was 1 mm or smaller (-0.02+/-0.16 vs. 0.10+/-0.22 mm). In addition, precision was better at the 90-degree angle than with the other angles in the 1024(2) matrix (overall precision=0.002 mm). In the 512(2) matrix, overall accuracy for the 90-degree angle was significantly underestimated compared with the 45-degree angle (-0.077 vs. 0.096 mm; p=0.02). In addition, accuracy for the 90-degree angle was better than that for the 45-degree angle below 1 mm (0.05+/-0.24 mm vs. 0.26+/-0.47 mm). In terms of overall accuracy, the 45-degree angle in the 512(2) matrix showed significant overestimation compared with that in the 1024(2) matrix (0.096 vs. -0.069 mm; p=0.015). There was no difference in accuracy in the 512 x 1024 matrix. Our results suggest that the direction of the vessel against the TV image affects accuracy of measurement in the QCA system.     

Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography

ObjectiveThe aim of this study was to assess the effectiveness and safety of different strategies of ivabradine therapy by comparing the effects on heart rate (HR), blood pressure (BP), and image quality of coronary CT angiography (CTA).MethodsA total of 192 consecutive patients were randomly assigned to 3 groups of oral premedication with ivabradine 15 mg (single dose), 10 mg (single dose), and 5 mg twice daily for 5 days, prospectively. Patients using HR-lowering drugs and patients with β-blockade contraindication were excluded. The target HR was 65 beats/min. In addition 5 to 10 mg of intravenous metoprolol was administered to the patients at the CT unit, if required. The systolic and diastolic blood BP values and the HRs were recorded. Image quality was assessed for 8 of 15 coronary segments with a 4-point grading scale. Results were compared with the Kruskal-Wallis test, one-way ANOVA, and χ² test.ResultsReductions in mean HR after the treatment were 18 ± 6, 14 ± 4, and 17 ± 7 beats/min for groups 1, 2, and 3, respectively. With the total additional therapies, 81.3%, 67.2%, and 84.3% of the patients achieved HR < 65 beats/min in groups 1, 2, and 3, respectively. The mean BP values before coronary CTA were not significantly changed except for patients in group 2. Unacceptable (score 0) image quality was obtained in only 4.5%, 10.2%, and 4.2% of all the coronary segments, in groups 1, 2, and 3, respectively.ConclusionsOur study indicates that coronary CTA with premedication with oral ivabradine in all 3 strategies is safe and effective in reducing HR, in particular with a β-blockade combination. All 3 ivabradine regimes may be an alternative strategy for HR lowering in patients undergoing coronary CTA. Ivabradine 15 mg (single dose) and ivabradine 5 mg twice daily for 5 days are superior to the ivabradine 10-mg single-dose regime for HR lowering without adjunctive intravenous β-blocker usage.     

High-resolution echography and angiography in the study of vascular accesses for hemodialysis

In 23 hemodialytic patients with clinically presumed complications of the vascular access the arteriovenous shunt was studied by high resolution ultrasonography (US) and by angiography. In 21/23 cases US identified the shape of the shunt correctly; in these patients US always showed the alterations of vascular size (stenosis, aneurysm) and complete occlusion, also detecting the intravascular extension of thrombosis. In 3 patients US identified partial venous thrombosis missed on angiography; furthermore, unlike angiography, US gave precise information on the vascular wall and perivascular tissue changes. These findings suggest that US may represent the first imaging procedure in the study of the vascular access in hemodialytic patients; angiography might be performed when US findings are uncertain or when a vascular map is needed for surgery.     

Comparison between different kernel reformatting filters in 3D quantitative analysis of MDCT coronary angiography

Purpose

Coronary angiography with multidetector-row computed tomography (MDCT-CA) allows quantification of coronary artery stenosis with a high level of accuracy; however, a better estimation of stenosis can be achieved by using appropriate reformatting filters, especially in stents and calcified segments. Quantitative computed tomography angiography (QCTA) is intended to overcome the limitations of the visual score. The aim of this study was to evaluate the accuracy of QCTA with different filters in comparison with quantitative coronary angiography (QCA) and visual score.

Materials and methods

Two blinded operators visually scored 17 consecutive patients referred for MDCT-CA with a per-segment analysis. The degree of stenosis was classified as 0?C20%, 20?C50% (wall irregularities), 50?C70% (significant disease) and 70?C100% (vessel occlusion). Each segment was then analysed using the electronic callipers of the QCTA system with 15 different filters. No contour editing was performed. Data were compared with QCA and conventional coronary angiography (CCA). Comparison between QCTA, visual score and QCA were performed using Spearman??s rank correlation.

Results

Of 25 segments analysed (mean 1.4 diseased segment per patient), 375 measurements were considered. Good correlation was found between the visual score and QCA [Pearson correlation coefficient (rho=0.852; p<0.0001)] and between QCA and CCA (rho=0.804; p<0.0001). Moderate correlation was found between QCA and QCTA only using two filters (rho=0.444; p<0.0001 for YA filter and rho=0.450; p<0.0001 for YB filter).

Conclusions

Overall QCTA accuracy is low if contour editing is not applied, especially in calcified vessels. Certain filters can help to better estimate the exact percentage of stenosis.     

不同对比剂对双源CT冠状动脉成像中患者心率的影响

目的 探究双源CT冠状动脉成像中,静脉注射碘克沙醇320与碘普罗胺370对比剂对患者心率的影响.方法 回顾性搜集行冠状动脉CTA检查的389例患者的病例资料,根据注射对比剂不同分为2组,A组采用碘克沙醇320,B组采用碘普罗胺370,记录CT增强扫描前屏气状态下心率(基础心率)、扫描过程中注射对比剂时屏气状态下心率(注射时心率).基础心率<75次/min时,舌下含服硝酸甘油0.25 mg.比较所有患者注射对比剂前后的心率变化并对2组患者的心率变化进行比较.结果 注射对比剂后心率变化>10次/min的患者A组有8例(4.4%),B组有10例(4.8%),2组无统计学差异(P>0.05).经静脉内注射对比剂时,2种对比剂均使患者心率减低(碘克沙醇下降4.2次/min、碘普罗胺下降2.7次/min,P>0.05),服用硝酸甘油均减轻对比剂对心率的影响.结论 经静脉注射碘克沙醇320与碘普罗胺370后,均约有4%的患者心率变化>10次/min,2种对比剂对心率的影响是一致的.     

Comparison of iopromide and iopamidol in left ventricular angiography and in coronary angiography

A double blind randomized trial of two non-ionic contrast media--iopamidol and iopromide--was performed on 101 patients undergoing left ventriculography and coronary angiography. Both products performed well in the trial and there were no statistically significant differences in side effects, cardiovascular parameters, blood analysis or film quality between the two products.     

Comparison of sodium-meglumine ioxaglate and iopromide in coronary angiography

A clinical study was carried out in 20 patients in coronary angiography to compare two low-osmolar contrast media, sodium-meglumine ioxaglate and iopromide. Ten patients presented a stage III coronary disease and the other ten had a stage IV coronary disease. In the latter group, 70% of the patients received sodium-meglumine ioxaglate and 30% were given iopromide. None of the patients given iopromide had a previous history of allergic-like reactions to contrast media as opposed to the sodium-meglumine ioxaglate group where two patients had a previous hypersensitivity reaction to contrast agents. In spite of these adverse conditions in the sodium-meglumine ioxaglate group, no significant difference was found between both preparations as to overall tolerability. The following side effects were observed: slight nausea and wheezing in a patient given sodium-meglumine ioxaglate; medium intense nausea, vomiting and headache in a patient administered iopromide; one case of angina pectoris occurring 8 minutes post-injection of iopromide. Similarly, no significant difference in overall cardiac tolerability could be found between the two contrast media, although sodium-meglumine ioxaglate would tend to be better tolerated in terms of heart rate and contractility. Radiographic efficacy was considered to be equivalent for both contrast agents though the test solutions had different iodine concentrations. In summary, the two low osmolar contrast media proved well tolerated and showed satisfactory diagnostic efficacy in this population at high cardiovascular risk.     

冠状动脉造影、平板运动及心电图对冠心病诊断的对比研究

目的探讨冠心病患者冠状动脉病变与常规静息心电图ST-T改变、平板运动试验的关系。方法对226例行冠状动脉造影的非心肌梗死病人的常规静息心电图、平板运动试验结果进行比较。结果常规静息心电图有ST-T改变的124例患者中,51例(41.13%)冠状动脉造影显示冠状动脉正常;除去心脏结构改变患者,仅有39例(31.45%)心电图ST-T改变是由冠状动脉病变引起。冠状动脉造影证实存在冠状动脉病变的150例患者中,77例(51.33%)常规静息心电图正常,其中75例(97.40%)平板运动试验阳性。结论冠状动脉造影是冠心病的一种有效的筛选方法,临床依据常规静息心电图ST-T改变诊断冠心病应慎重。