经桡动脉无鞘技术在冠状动脉左主干病变介入治疗中的应用

目的 评估经桡动脉无鞘技术在冠状动脉左主干病变介入治疗中的可行性及安全性.方法 对10例冠状动脉左主干病变患者采用经桡动脉无鞘技术行介入治疗,观察手术成功率和并发症情况.结果 10例患者中8例左主干病变累及前三叉,3例累及左主干开口;全部10例患者均选用7F指引导管经桡动脉无鞘技术成功完成手术,对8例累及左主干前三叉病变分别采用了 cullote 或crossover术式,7例患者最终进行了球囊对吻扩张;部分患者使用了血管内超声或切割球囊.随访期间无1例患者发生严重桡动脉穿刺并发症或主要不良心脑血管事件.结论 经桡动脉无鞘技术可作为一种安全、可行的方法应用于冠状动脉左主干病变的介入治疗中.     

经桡动脉入径采用球囊辅助技术协助的无鞘技术引导7 F指引导管完成冠状动脉复杂病变的初步经验

目的探讨经桡动脉入径采用球囊辅助技术(BAT)协助的无鞘技术引导7 F指引导管行经皮冠状动脉介入治疗(PCI)的可行性。方法前瞻性分析2019年1月至8月首都医科大学附属北京友谊医院心内科使用BAT协助的无鞘技术引导7 F指引导管行PCI患者的临床资料、影像资料、术后恢复情况,对该技术的可行性和安全性进行评价。结果12例患者采用BAT协助的无鞘技术引导7 F指引导管全部成功,无患者出现血管径路相关的并发症。所有患者PCI成功率为100%。结论经桡动脉入径采用BAT协助的无鞘技术引导7 F指引导管行PCI有很好的可行性和安全性,可作为部分复杂病变患者经桡动脉行PCI的首选方法。     

经桡动脉普通导引导管7F无鞘技术治疗冠状动脉复杂病变

目的 评价经桡动脉普通导引导管7F无鞘技术治疗冠状动脉复杂病变的安全性、可行性.方法 纳入2013年11月至2014年4月,经桡/尺动脉置入6F桡动脉鞘造影后,需要用7F导引导管行介入治疗的患者31例.在桡动脉鞘内置入长260 cm,直径0.036 in（1 in=2.54 cm）非亲水涂层导丝至升主动脉;撤出桡动脉鞘,将6 F 110 cm猪尾管插入7 F 100 cm导引导管内,猪尾管头端突出于导引导管外;将猪尾管和导引导管呈一体,穿入长260 cm,直径0.036 in导引导丝,通过皮肤切口逐次进入桡动脉,导引导管到位后撤出猪尾管.结果 31例导引导管均成功通过桡动脉,到达靶冠状动脉开口,完成介入治疗后撤出导引导管.术后观察24 h,所有患者桡动脉穿刺处无出血,穿刺侧上肢未发生血肿、感觉障碍.术后1个月随访,未发生桡动脉闭塞.结论 经桡动脉普通导引导管7F无鞘技术是治疗冠状动脉复杂病变可选用的相对安全、有效的途径.     

经桡动脉行冠状动脉造影及介入治疗的临床分析

目的 探讨经桡动脉行冠状动脉造影和介入治疗的优点和可行性.方法 对2006年5月-2009年12月住院的经桡动脉行冠状动脉介入诊疗患者1 340例患者的临床资料进行分析,观察手术成功率和并发症.结果 经桡动脉行冠脉造影和介入治疗成功率98.9%,术后并发症:桡动脉痉挛7例;术后穿刺部位小血肿16例,前臂肿胀11例,术后拔桡动脉血管鞘时发生血管迷走反射1例,桡动脉搏动减弱5例,桡动脉闭塞1例,无假性动脉瘤、动静脉瘘、局部感染和迷走神经反射等并发症.无死亡病例.结论 经桡动脉途径行冠状动脉介入诊疗是安全的、可行的.     

经桡动脉用7.5 F无鞘指引导管完成冠状动脉复杂病变介入治疗的初步经验

目的：总结北京友谊医院心血管病中心心内科使用无鞘指引导管（日本ASAHI）经桡动脉完成的60例冠状动脉复杂病变患者介入治疗的经验和体会。方法回顾分析患者的临床资料、影像资料以及术后恢复情况,对无鞘指引导管的使用特点进行总结分析。结果60例患者均为复杂冠状动脉病变,其中,慢性完全闭塞病变（CTO）13例,迂曲合并钙化病变17例,左主干病变7例,分叉病变32例（包括左主干病变7例和同时合并CTO病变2例）。行经皮冠状动脉介入治疗（PCI）,成功57例,失败3例,成功率95.0%。患者使用7.5 F的无鞘指引导管,均顺利通过桡动脉到位。左冠状动脉使用的无鞘指引导管型号依次为：JL3.5/4.0（44例）,AL1.0（3例）, SPB4.0/3.5（2例）,PB4.0（2例）;右冠状动脉：JR3.5/4.0（9例）。13例CTO病变使用的无鞘指引导管型号依次为：JL3.5/4.0（8例）,PB4.0（2例）,AL1.0（2例）,JR4.0（1例）;17例迂曲钙化病变：JL3.5/4.0（8例）,JR3.5/4.0（6例）,SPB3.5/4.0（2例）,AL1.0（1例）;32例分叉病变使用的无鞘指引导管型号均为JL3.5/4.0或JR3.5/4.0。结论经桡动脉使用7.5 F无鞘指引导管有良好的通过性,且导管管腔大、管壁厚、支撑力强,能胜任大多数分叉病变的双支架技术和对吻球囊技术,适合CTO、迂曲钙化病变等复杂病变的介入治疗。     

经桡动脉入路冠状动脉介入术后血管并发症的超声研究

目的应用血管超声对经桡动脉入路冠状动脉介入术后血管并发症及其发生的危险因素进行研究。方法选择152例拟行经桡动脉穿刺冠状动脉造影或介入治疗的患者,应用血管超声于术前及术后1个月测量其右侧桡动脉舒张期内径并结合血流频谱评价有无血管狭窄并发症。结果152例患者中148例(98%)成功经桡动脉行冠状动脉造影和/或介入治疗,所有患者均无动脉血肿、假性动脉瘤或动静脉漏,所有患者均无手部缺血症状。术后出现桡动脉血管并发症21例(局限性狭窄18例,占12·2%;弥漫性狭窄3例,占2·0%)。经桡动脉穿刺冠状动脉介入术前后桡动脉内径无明显差别(2·51±0·56mm对2·47±0·60mm,P>0·05)。多元回归分析显示,经桡动脉穿刺冠状动脉介入术后1个月出现桡动脉局限性或弥漫性狭窄的危险因素为桡动脉内径与动脉鞘管外径之差、操作时间和糖尿病。结论经桡动脉穿刺冠状动脉介入安全可靠。应用高频超声对桡动脉进行检查,术前有利于导管和动脉鞘的选择,特别是对合并糖尿病的患者更有意义;术后有利于血管并发症的发现。     

基层医院经桡动脉途径行冠状动脉介入的可行性

目的探讨在基层医院开展经桡动脉途径介入诊疗的可行性。方法回顾分析经桡动脉行冠状动脉造影或(和)经皮冠状动脉介入术患者389例的临床和手术情况,根据Allen试验结果分为桡动脉组和股动脉组,记录手术成功率和并发症。结果经桡动脉冠状动脉造影手术成功率为95.4%,经桡动脉经皮冠状动脉介入术成功率为92.6%,2例经桡动脉手术失败患者改股动脉入路手术成功,1例因病变复杂,需要较大支持力而改股动脉途径。术后局部出血2例,桡动脉痉挛2例,桡动脉闭塞1例又自发再通,无其他并发症。结论经桡动脉冠状动脉造影和经皮冠状动脉介入术安全有效,并发症少,不影响术后患者活动,降低住院费用,可在基层医院开展。但手术医师需要掌握一定的手术技巧和预防处理血管痉挛的经验。     

经皮穿刺桡动脉冠状动脉造影46例分析

目的 探讨经桡动脉冠状动脉造影的可行性、安全性及评价其效果。方法 经桡动脉冠状动脉造影患者46例，术前常规行改良Allen试验，阳性者行经右桡动脉冠状动脉造影术。结果 手术成功率为95．7％，2例失败，无出血、夹层、血肿等血管并发症发生，术后随访无桡动脉闭塞。结论 经皮穿刺桡动脉冠状动脉造影术是一种安全、可行的冠状动脉介入诊断新途径，具有止血容易、术后无须卧床休息和并发症少的优点。     

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

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)mm³,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。     

采用无鞘技术经桡动脉7F普通指引导管治疗冠状动脉病变

目的总结桡动脉无鞘技术进行普通7F指引导管治疗冠状动脉病变的安全性、可行性。方法入选30例冠心病患者采用普通6F桡动脉鞘行冠状动脉造影。造影后再沿造影导管送入长260cm,直径0.035英寸普通J型导丝至升主动脉;撤出造影导管和桡动脉鞘,保留260cm的长导丝在桡动脉内。往100cm长的7F指引导管内送入110cm长的6F猪尾巴导管,猪尾巴管头端突出于指引导管头端外形成组件;沿着260cm的导引导丝,将导管组件通过皮肤切口送入桡动脉,保留导丝调整指引导管到靶病变冠脉口。结果 30例单支血管病变2例,双支血管病变6例,三支血管病变22例;合并左主干病变3例。指引导管均成功通过桡动脉,到达靶冠状动脉开口,完成介入治疗后撤出指引导管。无并发症发生。术后1个月随访无桡动脉闭塞。结论采用无鞘技术经桡动脉行7F普通指引导管治疗冠状动脉病变安全可行。     

Minimally invasive transradial intervention using sheathless standard guiding catheters

Objectives : We evaluated a sheathless transradial technique for interventions using standard five and six French nonhydrophilic guiding catheters. Background : Miniaturization of transradial interventions may serve to improve patient comfort and reduce the risk of access‐site complications. Guiding catheters carry an outer diameter approximately 2 Fr sizes smaller than their corresponding introducer sheaths. Methods : We identified consecutive patients who underwent transradial intervention between August 2010 and December 2010 using 5 or 6 Fr guides with a sheathless technique. Results : A total of 11 patients were identified (mean age 70.7 ± 10.9 years; 73% male). Single coronary intervention was performed in 10 patients and renal artery intervention in one. Right radial access and 6 Fr guide catheters were used in the majority (each 73%). Five techniques were used to create an inner dilator as the taper. Four of these inner tapers (standard diagnostic catheters, hydrophilic diagnostic catheters, long sheath dilators and guide extensions) enabled successful sheathless guide insertion in all 10 patients attempted. One technique (a partially inflated angioplasty balloon protruding from the guide) attempted in one patient was unsuccessful. All interventional procedures were successful, there were no radial artery access‐site complications and in no case was cross‐over to femoral artery access‐site required. Conclusion : Sheathless transradial intervention using standard 5 and 6 Fr guiding catheters is a safe and effective method for treatment of coronary and peripheral vascular lesions. © 2011 Wiley Periodicals, Inc.     

Using sheathless standard guiding catheters for transradial percutaneous coronary intervention to treat bifurcation lesions

OBJECTIVE:

To investigate the feasibility and safety of using sheathless standard guiding catheters for transradial percutaneous coronary intervention (PCI) to treat bifurcation lesions.

METHODS:

Coronary bifurcation lesions were identified using angiography in 43 patients with coronary artery disease. These patients underwent transradial PCI using sheathless standard guiding catheters, and the procedural success and complication rates were recorded.

RESULTS:

All 43 patients underwent successful PCI. The Culotte stenting technique was used in 22 (51.2%) subjects, the Crush stenting technique was used in eight (18.8%) subjects and the crossover stenting implantation technique was used in 13 (30.0%) subjects. Of the 43 coronary artery bifurcation lesions, the final kissing balloon technique was performed in 39 (90.1%) lesions. Adjunctive devices used in the cohort included intravascular ultrasound for 32 (74.4%) patients, thrombus aspiration catheters for two patients and cutting balloon for five patients. During the perioperative period, no major complications associated with vessel puncture or adverse cardiac or cerebrovascular events occurred in any of the 43 patients enrolled in the present study. At day 30, radial artery occlusion was detected in only three (2.5%) patients and radial artery stenosis in four (9.3%) patients. At six-month follow-up, 24 (55.8%) patients exhibited coronary artery patency with no significant intimal hyperplasia.

CONCLUSIONS:

Transradial PCI using the sheathless technique may be a feasible and safe technique to treat coronary bifurcation lesions.     

Transradial percutaneous coronary interventions using sheathless guiding catheters: a multicenter registry

Background: Transradial approach (TRA) for percutaneous coronary interventions (PCIs) is a common alternative to transfemoral approach associated with lower complications. However, a limitation of TRA is the use of large caliber guiding catheters due to the small size of the radial artery. The sheathless guiding catheter system that is in diameter 1–2 French (Fr) smaller than the corresponding introducer sheath may overcome these difficulties. Methods: From January 2010 through December 2010 in 5 Italian high‐volume hospitals, 213 consecutive patients who underwent TRA‐PCIs using the sheathless Eaucath guiding catheter system because of small radial artery caliber (Group 1) or undergoing bifurcation PCIs (Group 2) were enrolled in this registry. In patients of Group 1 (n = 79), a 6.5‐Fr sheathless guiding catheter was employed, whereas in patients of Group 2 (n = 134) a 7.5 Fr was used. Results: Among the 213 patients enrolled, 270 vessels were treated for 316 lesions. No procedures required conversion to a conventional guiding catheter system. There were significantly more female patients in Group 1, and they were, older, shorter, and thinner than patients in Group 2. No cases of major vascular complications were observed in either groups. During procedures, adjunctive devices employed included intravascular ultrasound, thrombectomy catheters, and distal protection systems. Conclusions: The use of the sheathless guiding catheter system is feasible for TRA‐PCIs in case of small radial artery caliber or intended coronary bifurcation intervention. (J Interven Cardiol 2011;24:407–412)     

Renal artery intervention using a virtual 4.5‐Fr guiding catheter

A 6.5‐Fr guiding catheter (Parent Plus 45, Medikit, Tokyo, Japan), composed of a hydrophilic sheathless guiding catheter and a dilator, has recently been developed for the treatment of renal artery stenosis. Because of its unique sheathless configuration, its outer diameter is comparable to that of a conventional 4.5‐Fr introducer sheath, with the inner diameter being close in size to a 6.5‐Fr guiding catheter. These features allow this sheathless system to be used as the sole guiding catheter while the arterial damage at the puncture site remains equivalent to that of a 4.5‐Fr introducer sheath. We thus call this novel sheathless guiding catheter a virtual 4.5‐Fr system. To demonstrate the potential of this virtual 4.5‐Fr system, we report a case of renal artery stenosis successfully treated via the transradial route. This virtual 4.5‐Fr system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity. © 2012 Wiley Periodicals, Inc.     

Feasibility and safety of the successive use of distal transradial access for coronary angiography and intervention in the same arm

Distal transradial access (dTRA) is a novel alternative to conventional radial artery access for coronary catheterization. However, the feasibility and safety of repeated use of dTRA have not been fully elucidated. This study aimed to evaluate the feasibility and safety of the repeated use of dTRA for coronary angiography and intervention in the same arm. A total of 1717 patients underwent angiography or angioplasty via dTRA. We retrospectively analyzed the catheterization records of patients who underwent repeated puncture of the distal radial artery in the same arm. The incidence of successive applications of dTRA and the reasons for dropout were retrospectively investigated. A total of 416 patients, including three who underwent coronary catheterization with the bilateral dTRA in the initial attempt were analyzed. A 3-, 4-, 5-, or 6-French sheath or sheathless guide catheter was used in the initial procedure. A maximum of four successive coronary catheterization procedures were performed. The second procedure with dTRA on the same arm was successfully performed in 395 cases (94.3%), with a successive rate of 89.6% for both the third and fourth dTRA procedures. Conversion to another approach site (n = 30) was attributed to radial artery occlusion (n = 9), narrowing of the distal radial artery (n = 19), and puncture failure (n = 2). The current data indicate that the repeated use of dTRA is safe and feasible, and this approach may become a standard approach site in the future.     

Percutaneous coronary intervention using a virtual 3‐Fr guiding catheter

Background : We have recently reported a novel percutaneous coronary intervention (PCI) system using a hydrophilic‐coated sheathless guiding catheter (Virtual 3‐Fr, Medikit, Tokyo, Japan), which provides us with less invasive angioplasty and a puncture site injury equivalent to a conventional 3‐Fr introducer sheath. Here, we report the initial results of PCI using this novel system. Methods : A total of 36 coronary artery lesions of 27 patients were treated by using a virtual 3‐Fr PCI system. Procedural outcomes of virtual 3‐Fr PCI were retrospectively evaluated. Results : The mean age was 73.0 ± 8.7 years (range, 46–84 years), and 15 were men (56%). Access sites included the radial artery in 18 patients (67%), the brachial artery in eight patients (30%), and the femoral artery in 1 patients (4%). Among 36 lesions, seven were chronic total occlusions, and a virtual 3‐Fr PCI was successful in 33 lesions (92%). Among the successfully treated 33 lesions, coronary stents were deployed in 32 (97%), and intravascular ultrasound examination was performed in 19 (58%). Hemostasis was achieved immediately after PCIs in all cases. No access‐site related complications including radial artery occlusion were observed. Conclusions : The performance of a virtual 3‐Fr PCI system appears to be comparable to one using a regular 5‐Fr guiding catheter while the puncture‐site damage remains equivalent to that of a 3‐Fr introducer sheath. Virtual 3‐Fr PCI may have a potential to serve as a minimally invasive strategy for the treatment of coronary artery diseases. © 2010 Wiley‐Liss, Inc.     

Transradial coronary intervention using a novel 5‐Fr sheathless guiding catheter

We have recently developed a 5‐Fr sheathless guiding catheter system (Virtual 3‐Fr, Medikit, Japan), composed of a hydrophilic catheter and a central dilator. This combination of catheter and dilator enables us to introduce the catheter into the artery without the need of an introducer sheath. Because the outer diameter of this 5‐Fr sheathless guiding catheter system is approximately 2‐Fr sizes smaller than a conventional guiding catheter system, this system provides us with less invasive angioplasty and a puncture site injury equivalent to a conventional 3‐Fr introducer sheath. To demonstrate the potential of this 5‐Fr sheathless guiding system, we report two cases of chronic total occlusion successfully treated by the transradial approach. This novel 5‐Fr sheathless system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity. © 2009 Wiley‐Liss, Inc.