非全身肝素化冠状动脉造影安全性的临床评价

目的评价非全身肝素化状态下冠状动脉造影（CAG）的安全性。方法100例择期冠状动脉脉造影的病人随机分为常规肝素抗凝组50例（肝素组）和无肝素抗凝组50例（非肝素组），非肝素组要求从鞘管进入股动脉到CAG结束在10min内完成。观察CAG期间及其后6h内病人发生卒中、新发生的外周动脉血栓、穿刺及非穿刺部位出血并发症情况。结果肝素组术中及术后无卒中、新发生的外周动脉血栓和非穿刺部位出血发生，穿刺部位血肿4例（8．0％）；非肝素组术后1例（2．0％）发生短暂性脑缺血发作，无新发生的外周动脉血栓、穿刺和非穿刺部位出血发生。结论对技术熟练的术者，在10min内，非全身肝素化状态下完成从鞘管进入股动脉到CAG操作是安全的，可减少穿刺和非穿刺部位出血并发症的发生。     

经皮股动脉穿刺非肝素化冠状动脉造影术后6小时下地活动的可行性

目的观察使用6F动脉鞘管、经皮股动脉穿刺非肝素化冠状动脉造影术后患者拔除鞘管6h后下地活动的可行性和安全性。方法2007年9月至2008年3月,用前瞻性、随机对照的方法连续观察150例经皮股动脉行冠状动脉造影的患者,按人工压迫止血后下地活动时间分为6h下地活动组(6h组)和常规12h下地活动组(12h组),对比观察两组住院期间穿刺部位并发症和患者舒适度。结果6h组卧床时间明显短于12h组[(6.47±2.41)h比(12.51±2.60)h,P<0.001],两组并发症差异无统计学意义(10.6%比5.3%,P>0.05),腰痛和导尿的患者在6h组明显低于12 h组(9.8%比35.2%,1.2%比10.3%,均为P<0.05)。结论使用6 F动脉鞘经皮股动脉穿刺非肝素化行冠状动脉造影、人工压迫止血后6 h下地活动是可行和安全的。     

无肝素冠脉造影术后股动脉止血方法的探讨

目的：评价无肝素股动脉冠状动脉造影术（CAG）后股动脉穿刺部位应用改良加压包扎法止血的效果和安全性。方法：经股动脉途径行CAG的120例患者,分为两组,A组术后采用Angio—seal．装置止血,B组采用改良加压包扎法止血,两组抗血小板治疗相同。比较两组止血时间、止血成功率、开始活动时间、并发症和患者的舒适度。结果：①两组止血的成功率（均为100％）,制动时间[A组为（3．6±0．7）h,B组（3．8±0．5）h]．舒适度均无显著差异（P〉0．05）;②止血时间[A组（2．1±0．8）min．B组（7．5±2．8）min],加压包扎时间[A组0h,B组为（10．2±2．3）h],A组显著短于B组（P〈0．05）;③主要并发症：血肿发生率A组（11．7％）显著多于13组（3．3％）．P〈0．05。结论：无肝素股动脉冠状动脉造影术后股动脉穿刺部位应用改良加压包扎法止血效果好．价格低廉。并发症少,值得临床推广。     

274例经皮桡动脉穿刺介入术治疗冠心病

目的　探讨经桡动脉介入治疗冠心病的可行性和安全性。方法　 6 0 8例冠心病患者分别经桡动脉 (2 74例 ,A组 )或经股动脉 (334例 ,F组 )途径接受介入治疗 ,观察两组手术成功率和术后并发症情况。结果　两组患者接受选择性冠状动脉造影 (CAG)或经皮腔内冠状动脉成形术 (PTCA)的手术成功率差异无显著性。A组局部血肿发生率显著低于F组 ,无假性动脉瘤 (F组 7例 ,P <0 0 5 )等其他血管及皮肤并发症 ,1例发生术侧肢体浮肿 ;F组出现 1例动静脉瘘、2例术侧肢体浮肿、4例穿刺部位感染、5例穿刺部位表皮坏死 ,但两组相比差异均无显著性。两组均无远端肢体缺血。结论　经桡动脉途径行经皮冠状动脉介入治疗术后并发症少 ,可行性高 ,安全有效 ,但需要一定的经验。     

经桡动脉和股动脉途径行冠状动脉介入治疗932例临床对比分析

目的:探讨经桡动脉途径行冠状动脉介入治疗的安全性及可行性。方法:选取行冠状动脉造影和经皮冠状动脉成形术或支架植入术的患者932例,其中494例经桡动脉途径,438例经股动途径,比较两组的穿刺成功率、手术成功率、穿刺部位止血包扎时间、肢体制动时间及并发症。结果:两组手术成功率差异无统计学意义(96.6%︰97.1%);经桡动脉组穿刺成功率略低于经股动脉组(P0.05);经桡动脉组在鞘管置入时间上长于股动脉组,而止血包扎时间和肢体制动时间则明显短于股动脉组(P0.05)。经桡动脉组穿刺部位血肿、假性动脉瘤、血管迷走神经反射、术后尿潴留发生率明显低于股动脉组(P0.05),而动脉痉挛发生率明显高于股动脉组(P0.05)。结论:经桡动脉途径行冠状动脉介入治疗是安全、有效、可行的,值得临床推广应用。     

Allen试验阴性患者经肱动脉和股动脉冠状动脉造影的对比研究

目的探讨经肱动脉和股动脉途径冠脉造影的优缺点。方法选择我院行冠脉造影的患者60例,均为Allen试验阴性患者,随机分为肱动脉组和股动脉组,每组30例,比较两组的穿刺成功率、造影成功率、手术操作时间、曝光时间、术后压迫时间及术后并发症。结果与股动脉组比较,肱动脉组术后平均压迫时间明显减少,差异有统计学意义(P<0.01),且患者无需卧床。而两组在穿刺成功率、造影成功率、手术操作时间、曝光时间等方面差异无统计学意义(P均>0.05)。结论对于Allen试验阴性不能经桡动脉穿刺的患者,包括桡动脉痉挛或闭塞的患者,经肱动脉行冠状动脉造影是安全可靠的替代方法,避免了股动脉穿刺后长时间卧床。     

经肱动脉与经股动脉行肾动脉造影术的对比分析

目的 对比两种途径行肾动脉造影术的临床应用价值.方法 选择2005年7月至2008年7月收住院血压控制不良的疑似冠心病患者100例,按不同的途径分为2组:经肱动脉造影组50例,经股动脉造影组50例,均在冠状动脉造影结束即刻同途径行选择性肾动脉造影,对比观察两组在肾动脉造影期间造影所用时间、造影剂用量、手术成功率、卧床时间及手术并发症发生率.结果 两组共检出肾动脉狭窄患者25例,其中6例双侧肾动脉狭窄.两组造影所用时间、造影剂用量差异无统计学意义(P＞0.05),手术成功率股动脉组略高,经肱动脉造影组卧床时间、并发症发生率低于经股动脉造影组(P＜0.05).结论 经肱动脉行选择性肾动脉造影具有穿刺部位血管并发症少、止血容易、术后即刻可以活动的特点,可以考虑作为股动脉途径的替代途径加以推广应用.     

女性患者经桡动脉与经股动脉行经皮冠状动脉介入治疗的安全性和疗效比较

目的:对女性患者经桡动脉与经股动脉路径行经皮冠状动脉介入治疗(PCI)的安全性和疗效进行评价。方法:回顾性纳入阜外医院2006-01-01至2011-04-30间行PCI的女性患者5 067例,其中,经桡动脉路径者4 105例(桡动脉组),经股动脉路径者962例(股动脉组)。采用1:1倾向性评分匹配模型对两种路径进行配对,成功匹配897对患者。比较两组路径行PCI的安全性及疗效。结果:经过倾向性评分匹配后,两组患者的临床特点、造影与介入相关信息均基本相似。在倾向性评分匹配的患者中,桡动脉组出血学术研究联合会(BARC)分级≥2级和≥3级出血事件以及穿刺点并发症发生率仍显著低于股动脉组(P均0.05)。桡动脉组的院内主要不良心血管事件(MACE)、心肌梗死、靶血管血运重建事件率均低于股动脉组,但差异均无统计学意义(P均0.05);心原性死亡率显著低于股动脉组(P0.05),但经过倾向性评分匹配后此差异亦无统计学意义(P0.05)。多因素Logistic回归结果显示,桡动脉路径是PCI后严重出血(OR=0.64,95%CI:0.54～0.76,P0.001)和穿刺点并发症(OR=0.67,95%CI:0.61～0.74,P0.001)的独立阴性预测因素。结论:对于女性患者而言,经桡动脉路径行PCI能够显著减少严重出血及穿刺点并发症的发生。     

两种途径行冠状动脉造影术的对比分析

目的评价经股动脉和桡动脉途径行冠状动脉造影的优缺点。方法将我院2004年7月到2006年8月住院期间冠状动脉造影患者436例,按股动脉途径和桡动脉途径分为两组,比较其穿刺时间、穿刺成功率、x线照射时间、制动时间、穿刺部位并发症。结果股动脉血管穿刺成功率高于桡动脉组,穿刺时间小于桡动脉组,股动脉组术后并发症高于桡动脉组。结论经桡动脉途径冠状动脉造影安全可行,并发症少,适合于择期造影者及老年人。经股动脉途径行冠状动脉造影,穿刺时间短,成功率高,适用于急诊患者。     

低分子肝素和普通肝素在主动脉内球囊反搏术中抗凝应用的临床观察

目的:观察低分子肝素(LMWH) 和普通肝素（UFH）在主动脉内球囊反搏术（IABP）中抗凝应用的临床效果。方法: 68例安置IABP的患者随机分为应用UFH抗凝的常规组（34例）和应用LMWH抗凝的试药组（34例），观察两组患者的出血、血肿、血栓形成等并发症发生情况及费用差别。结果: 两组均只有少部分患者有伤口少量渗血、局部小血肿和伤口周围轻度青紫等表现，无其它并发症出现，两组比较差异无显著性。但试药组的费用比常规组低，两组比较差异有显著性。结论: 在IABP中应用LMWH可以达到应用UFH相同的抗凝、预防血栓形成的效果，同时并发症无增加，而费用减少。     

Systemic Heparinization During Percutaneous Coronary Angiography: Evaluation of Effectiveness in Decreasing Thrombotic and Embolic Catheter Complications

Systemic heparinization has been advocated as preventive for thrombotic and embolic complications of arterial catheterization. To test this hypothesis, 95 patients undergoing coronary angiography via the percutaneous femoral arterial approach were randomized into heparinized and nonheparinized groups. Evaluation for thrombotic and embolic complications by clinical means and noninvasive electrical impedance flow measurements in the lower limbs was performed precatheterization, postcatheterization, and at 4 and 24 hr. Clinical data reveal loss of distal leg pulses in 11% (5/47) of the nonheparinized group, with two of these individuals developing signs of claudication and requiring embolectomy. No individuals (0/48) in the heparinized group lost distal leg pulses. Immediate, 4-hr, and 24-hr postcatheterization bloodflow was 12%, 10%, and 12% lower, respectively, in the catheterized limb of those in the nonheparinized group. At 24 hr 52% of the nonheparinized group had bloodflow levels lower than the precatheterization levels in the right (catheterized) extremity, while 2% (2/48) of the heparinized group had a similar reduction. One possible complication of excess bleeding was noted with heparin. It is concluded that systemic heparinization is safe and can be an important adjunct in the reduction of thromboembolic complications of percutaneous coronary angiography.     

Systemic heparinization during percutaneous coronary angiography: evaluation of effectiveness in decreasing thrombotic and embolic catheter complications.

Systemic heparinization has been advocated as preventive for thrombotic and embolic complications of arterial catheterization. To test this hypothesis, 95 patients undergoing coronary angiography via the percutaneous femoral arterial approach were randomized into heparinized and nonheparinized groups. Evaluation for thrombotic and embolic complications by clinical means and non-invasive electrical impedance flow measurements in the lower limbs was performed precatheterization, postcatherization, and at 4 and 24 hr. Clinical data reveal loss of distal leg pulses in 11% (5/74) of the nonheparinized group, with two of these individuals developing signs of claudication and requiring embolectomy. No individuals (0/48) in the heparinized group lost distal leg pulses. Immediate, 4-hr, and 24-hr post-catheterization bloodflow was 12%, 10%, and 12% lower, respectively, in the catheterized limb of those in the nonheparinized group. At 24 hr 52% of the nonheparinized group had bloodflow levels lower than the precatheterization levels in the right (catheterized) extremity, while 2% (2/48) of the heparinized group had a similar reduction. One possible complication of excess bleeding was noted with heparin. It is concluded that systemic heparinization is safe and can be an important adjunct in the reduction of thromboembolic complications of percutaneous coronary angiography.     

Percutaneous coronary intervention in anticoagulated patients via radial artery access

Objectives: To assess safety and feasibility of using radial artery access for percutaneous coronary intervention (PCI) in patients on oral anticoagulation without interrupting therapy. Background: The radial artery approach for PCI is intuitively attractive for patients receiving chronic oral anticoagulation with vitamin K antagonists (VKAs) but little data exist concerning feasibility or safety of this approach in this population. The main advantage of this strategy would be to avoid bridging therapy with heparin that increases risk of thrombotic and bleeding events. Methods: In this prospective observational study, 50 consecutive patients referred for coronary angiography underwent PCI without interrupting oral anticoagulant therapy. The main outcome measures were bleeding and thrombotic complications. Results: The indications for permanent oral anticoagulation were as follows: atrial fibrillation in 62%, mechanical prosthesis in 24%, and venous thromboembolism in 14%. Seventy‐two percent were elective cases and 28% presented with acute coronary syndromes. PCI was performed with an INR range of 1.4–3.4 with mean of 2.2 ± 0.6. Seventy‐six percent of the patients were on dual antiplatelet therapy before the procedure. No thrombotic events or excess bleeding were observed at 1 month. Only one patient had a minor hemorrhage 8 days after procedure. Conclusions: This series suggests that for patients treated with VKAs, the use of radial artery access is feasible and safe for PCI on dual antiplatelet therapy without interrupting oral anticoagulant treatment. © 2008 Wiley‐Liss, Inc.     

Optimal strategy for administering enoxaparin to patients undergoing coronary angiography without angioplasty for acute coronary syndromes

The optimal strategy for administration of low molecular weight heparin in patients with acute coronary syndrome (ACS) undergoing coronary angiography without percutaneous coronary intervention remains unclear. We studied postangiographic vascular complications in 325 consecutive patients (210 men and 115 women, mean age 63 years) with ACS undergoing diagnostic coronary angiography via a femoral approach followed by immediate sheath removal. At the time of angiography, 44 patients were on intravenous unfractionated heparin (UFH), 229 on subcutaneous enoxaparin, and 52 on no heparin. Enoxaparin was withheld on the morning of angiography in 181 of 229 patients: the no A.M. dose group. Vascular complications were audited, including hematoma development at angiographic puncture sites; these complications were considered significant if >25 cm(2). Major vascular complications requiring transfusion or surgical interventions were infrequent in all groups. Patients receiving enoxaparin on the morning of angiography had a twofold increase in significant hematoma rate compared with the no A.M. dose group (31% vs 16%; p = 0.015). The no A.M. dose group had hematoma rates similar to UFH (20%; p = NS) and no anticoagulation (13.5%; p = NS). No significant increase in ischemic episodes occurred as a result of withholding enoxaparin in the no A.M. dose group. We conclude that omission of enoxaparin on the morning of cardiac catheterization results in vascular complications rates comparable to that of UFH without precipitating rebound ischemia. This is a practical, safe strategy for patients with ACS undergoing coronary angiography, allowing early mobilization for most patients who do not proceed to immediate percutaneous coronary intervention.     

Successful use of the Cardiva Boomerang™ vascular closure device to close a brachial artery puncture site after emergency PTCA

Brachial artery access is a good alternative for performing percutaneous transluminal angioplasty when femoral access is contraindicated or not feasible. Although several closure devices are available for femoral access, haemostasis for brachial artery access is still achieved by manual compression with several potential complications, such as bleeding, pseudo-aneurysm formation, especially in patients in which heparin is administered, or thrombotic vessel occlusion. This first-in-human report describes the off-label brachial use of the Cardiva Boomerang™, a novel vascular closure device, which provides haemostasis using a temporary intravascular tampon, thus permitting the easier physiological closure of the puncture site without any important complications.     

Local treatment with an antithrombotic drug reduces thrombus size in coronary and peripheral thrombosed arteries

Summary Since the treatment of thrombotic disease by antithrombotic drugs may be associated with bleeding complications, a local delivery technique for administration of the drug may be useful. The efficacy of low-dose local delivery of an antithrombotic drug on thrombosis was investigated in 73 dogs. The antithrombotic drug (heparin, 25U/kg, antithrombin: argatroban, 0.05mg/kg, or defibrinogenating agent: batroxobin, 0.05U/kg) was infused locally to a 1-h-old thrombus, and no drug was given in controls. The effect of the local delivery on the thrombus was evaluated. Low- and high-dose systemic drug delivery was also evaluated. The mean reduction in thrombotic coronary stenosis observed by angiography was 30.3% with argatroban, 22% with heparin, and 20.8% with batroxobin (P < 0.005 vs controls). Systemic delivery of low-dose heparin or argatroban did not induce any change in thrombus size. With high-dose systemic drug delivery (heparin 250 U/kg, argatroban 0.5 mg/kg), the mean reduction of thrombotic stenosis was 15.2% with heparin and 32.8% with argatroban (P < 0.005 vs controls). In iliac arterial thrombosis, after local delivery of the drugs, the mean reduction of thrombotic stenosis observed by angiography was 24.4% in the argatroban group, and 19.2% in the heparin group (P < 0.05 vs controls, respectively). With high-dose systemic heparin delivery, the mean reduction of the thrombotic stenosis was 13.2% (P < 0.01 vs control). Angioscopy also demonstrated a similar trend. The high-dose drug delivery reduced systemic coagulability. Thus, local delivery of an antithrombotic agent can reduce the thrombus size in the coronary and iliac arteries without having any significant influence on coagulability.     

Improvements in balloon aortic valvuloplasty: Closure devices for large artery access

Objectives : To prospectively compare the efficacy and procedural safety of the radial versus femoral route for cardiac catheterization during uninterrupted warfarin therapy. Background : The optimal treatment strategy for cardiac catheterization in patients receiving long‐term oral anticoagulation has not been defined. Increasing evidence suggests the feasibility and safety of catheterization without warfarin interruption. However, the relative safety and efficacy of the radial and femoral access in fully anticoagulated patients are unknown. Methods : Fifty‐six consecutive patients on chronic warfarin treatment with international normalized ratio (INR) between 1.8 and 3.5 were randomized to undergo coronary angiography, alone, or followed by percutaneous coronary intervention (PCI), via the femoral (n = 29) or radial route (n = 27). Procedural success, in‐hospital major adverse cardiac and cerebrovascular events, access‐site, and bleeding complications were recorded. Results : The two groups were well balanced with similar clinical characteristics at baseline. There were no significant differences in preprocedural antiplatelet therapy or in INR levels between the radial and femoral group (2.62 ± 0.7 vs. 2.48 ± 0.6, respectively, P = 0.63). Procedural success was achieved in all femoral patients, whereas one patient in the radial group (3.7%) required crossover to femoral access. Eight patients from the femoral and 10 patients from the radial group successfully underwent PCI. Access‐site complications occurred only in patients who underwent PCI: three (37.5%) in the femoral versus none in the radial group (P = 0.034). Conclusion : The radial access is as efficacious and safe as the femoral route for coronary angiography in fully anticoagulated patients, but is likely to result in fewer access‐site complications in patients who also undergo PCI. © 2010 Wiley‐Liss, Inc.     

Rapid cycle change to predominantly radial access coronary angiography and percutaneous coronary intervention

Objectives : This study sought to evaluate the safety and feasibility of all operators at a single center changing from predominantly femoral to radial access for coronary percutaneous procedures. Background : The radial artery is currently regarded as a useful vascular access site for coronary angiography and percutaneous coronary intervention (PCI). The reduction in local vascular access complications is thought to be a major advantage of the radial route. Despite this, the technique is used less frequently possibly reflecting concerns by cardiologists about the feasibility of using radial access as a preferred option. Methods : A retrospective study of 1004 consecutive patients who underwent coronary angiography with or without PCI was analyzed. Procedure details and clinical outcomes were assessed according to the radial or femoral approaches. Results : The success rate for cardiac catheterization via the radial approach was 97.4% (815/837) and the femoral approach was 98.8% (165/167). The procedural failure rate for radial access was not different from the femoral route [2.6% vs. 1.2%; odds ratio (OR), 2.26; 95% confidence interval (CI), 0.53–9.71; P = 0.41]. Major access site complications occurred in 0.25% patients in the radial group compared with 4.8% patients in the femoral group [OR, 0.05 (95% CI, 0.01–0.23); P < 0.0001]. Conclusions : The radial approach has a high rate of success and is associated with fewer major local vascular access site complications than the femoral route. These results can be achieved early in the operator learning curve of low to medium volume operators. © 2011 Wiley Periodicals, Inc.     

Left radial approach for coronary angiography: Results of a prospective study

Although radial approach has been shown to be feasible for coronary angiography, angioplasty, and even stent placement, there have been no prospective evaluations of ease and safety of left radial approach for coronary angiogram. We examined procedural duration and success as well as complications in 415 consecutive patients. Radial artery occlusion was assessed immediately post-procedure and at 2 month follow-up using echo-Doppler measurements. Procedure failure rate was 9%, mean time for sheath insertion was 4.7 ± 4.7 min, and mean procedure duration was 19.1 ± 8.2 min. No major complications occurred. Asymptomatic radial artery occlusion was noted in 71% of the first 49 patients, decreased to 24% in the next 119 receiving 2,000–3,000 units of heparin, and to 4.3% in the last 210 receiving 5000 (p < 0.05). Comparison with the femoral approach in the same laboratory suggested that the radial approach took longer, but provided similarly high-quality results without great difficulty in coronary cannulation. Hence, the left radial approach for coronary angiography (with heparin administration) allows immediate ambulation and may be especially useful for outpatients and when the femoral approach is not possible. © 1996 Wiley-Liss, Inc.     

Feasibility of complex coronary and peripheral interventions by trans‐radial approach using large sheaths

Background : Trans‐radial approach (TRA) reduces vascular access‐site complications but has some technical limitations. Usually, TRA procedures are performed using 5 Fr or 6 Fr sheaths, whereas complex interventions requiring larger sheaths are approached by trans‐femoral access. Methods : During 4 years, at two Institutions with high TRA use, we have attempted to perform selected complex coronary or peripheral interventions by TRA using sheaths larger than 6 Fr. Clinical and procedural data were prospectively collected. Attempt to place a 7 Fr or 8 Fr sheath (according to the planned strategy of the procedure) was performed after 5–6 Fr sheath insertion, administration of intra‐arterial nitrates and radial artery angiography. Late (>3 months) patency of the radial artery was checked (by angiography in the case of repeated procedures or by palpation + reverse Allen test). Results : We collected 60 patients in which TRA large sheath insertion was attempted. The large sheath (87% 7 Fr, 13% 8 Fr) was successfully placed in all cases. Most of the procedures were complex coronary interventions (bifurcated or highly thrombotic or calcific chronic total occlusive lesions), whereas 8.3% were carotid interventions. Procedural success rate was 98.3% (1 failure to reopen a chronic total occlusion). No access‐site related complication occurred. In 57 (95%) patients, late radial artery patency was assessed and showed patency in 90% of the cases, the remaining patients having asymptomatic collateralized occlusion. Conclusions : In selected patients, complex percutaneous interventions requiring 7–8 Fr sheaths can be successfully performed by RA approach without access‐site clinical consequences. © 2011 Wiley Periodicals, Inc.