经桡动脉穿刺冠状动脉复杂病变的介入治疗

目的　探讨复杂冠状动脉病变经桡动脉穿刺途径行介入治疗的成功率和并发症。方法　 184例复杂冠状动脉病变的冠心病心绞痛患者中 ,经桡动脉穿刺组 4 6例 ,对照组为经股动脉穿刺者 138例 ,观察两组手术成功率、术后并发症等情况。结果　经桡动脉组手术成功率为 92 .2 % ,与经股动脉组 (94 .9% )相比无明显差异 (P>0 .0 5 )。但术后与穿刺有关的并发症发生率 ,经桡动脉组明显少于经股动脉组 (10 .8% vs 2 8.3% ,P<0 .0 5 ) ;术后卧床时间也明显短于经股动脉穿刺组 (P<0 .0 1)。而经桡动脉组从穿刺开始至指引导管放置成功所需的时间长于经股动脉组(P<0 .0 5 )。结论　经选择的冠状动脉复杂病变经桡动脉途径介入治疗具有较高的成功率。经桡动脉途径术后与穿刺有关的并发症发生率低。     

桡、股动脉途径冠状动脉介入治疗无保护冠状动脉左主干病变的对比研究

目的 评价经桡动脉途径冠状动脉介入治疗无保护左主干病变的可行性和安全性.方法 2004年3月至2006年9月,分别经桡动脉(36例)或股动脉(51例)途径完成87例无保护左主干病变患者的冠状动脉介入治疗,并观察不同入路介入治疗左主干病变的成功率、手术操作时间、造影剂用量、术后并发症以及临床随访期间发生严重心脏不良事件(MAcE)的情况.结果 在37例选择经桡动脉介入治疗的患者中仅1例患者因术中出现桡动脉痉挛而改为股动脉途径,桡动脉介入治疗的手术成功率为97.3%,两组患者完成手术的操作时间(59.2±15.0 mm比56.9±22.3 min)和造影剂用量(216±33 mL比205±41 mL)无明显差异,但经桡动脉途径介入治疗患者血管并发症的发生率(0)明显低于股动脉介入治疗患者(3.9%);临床随访6个月,仅1例股动脉介入治疗组患者死亡,分别有1例经桡动脉介入患者和2例经股动脉介入治疗患者随访期间接受了靶病变血运重建(TLR)治疗,随访期间总MACE的发生率桡动脉组为3.1%,股动脉组患者为5.7%,两组患者间差异无统计学意义.结论 相比于股动脉途径,经桡动脉途径冠状动脉介入治疗无保护左主干病变具有同样的临床效果,而且血管并发症的发生率要明显低于股动脉途径的介入治疗.     

经桡动脉穿刺冠状动脉造影后即刻经桡动脉介入治疗

目的探讨冠心病心绞痛患者经桡动脉穿刺冠状动脉造影术后即刻选择经桡动脉行冠状动脉介入治疗的可行性、并发症以及近期疗效。方法选择临床诊断为冠心病心绞痛经桡动脉造影显示明确的冠状动脉病变后即刻采取经桡动脉介入治疗(PCI)的患者117例(桡动脉组),与同期经股动脉途径造影后即刻PCI者(股动脉组,共409例)进行比较,分析两组靶血管病变特征、疗效和并发症,并随访术后1月内心绞痛复发、心肌梗死、死亡等主要心血管事件的发生率。结果桡动脉组PCI成功率为94.0%,与股动脉组(97.6%)相比无明显差异(P>0.05)。桡动脉组造影显示明显病变(管腔狭窄程度≥70%)的血管数量累计为210支,其中182支作为靶血管进行了成功的PCI,病变血管的血运重建率为86.7%,低于股动脉组(93.4%),差异具有显著性(P<0.01)。而且成功PCI者中慢性闭塞病变的所占的比例也明显低于股动脉组,差异具有显著性(P<0.05)。桡动脉组术后与穿刺有关的总的并发症的发生率明显低于股动脉组(P<0.01)。术后平均卧床时间和平均住院天数均明显短于股动脉组。随访PCI术后1个月期间主要心血管事件两组之间无明显差异(P>0.05)。结论经桡动脉穿刺冠状动脉造影术后即刻行冠状动脉介入治疗的成功率较高,并发症少,具有可行性。但对于复杂病变选择经股动脉途径PCI     

基层医院开展经桡动脉途径冠状动脉介入治疗的可行性研究

目的探讨经桡动脉和股动脉行冠状动脉介入治疗的优缺点,及在基层医院开展经桡动脉介入治疗的可行性。方法将112例住院的冠心病患者随机分为经桡动脉介入治疗组58例,经股动脉介入治疗组54例。观察两组手术成功率、住院天数、球囊及特殊导管使用率、手术操作时间和并发症的发生率。结果经桡动脉组与经股动脉组成功率无显著差异,而局部血管并发症少(P<0.05),住院天数明显缩短(P<0.01),但经桡动脉组球囊使用率高(P<0.05),特殊导管使用率也较经股动脉组高(P<0.01),手术耗时长(P<0.01),动脉痉挛发生率也高于经股动脉组但无显著性差异(P>0.05)。结论经桡动脉途径行冠状动脉介入治疗术患者痛苦少、血管并发症少,且手术成功率高,适合在基层医院开展。但在开展经桡动脉介入治疗前,应积累大量的经股动脉冠状动脉介入治疗术和经桡动脉冠脉造影术的实践经验。     

冠心病患者冠状动脉介入治疗两种路径的比较

目的:比较冠心病患者冠状动脉介入治疗两种路径,以说明经桡动脉路径的优越性。方法: 选择行经皮冠状动脉介入治疗的423例冠心病患者,按采用的路径分为经桡动脉路径组（桡动脉组,213例）和经股动脉路径组（股动脉组,210例）,分析两组间首次穿刺置管成功率、手术成功率、平均住院日及术后并发症的发生率。结果: 两组间首次穿刺置管成功率、手术成功率比较无显著差异。桡动脉组平均住院日、局部血肿、尿潴留、失眠、烦躁及并发症的总发生率均显著低于股动脉组,两组间比较有显著性差异（P<0.05）。结论: 经桡动脉路径行经皮冠状动脉介入治疗安全可行,可以作为首选路径。     

经肱动脉途径介入治疗冠状动脉复杂病变研究

目的探讨经肱动脉途径行冠状动脉腔内成形术治疗复杂冠状动脉病变的可行性。方法将100例患者随机分为经肱动脉途径行经皮冠脉介入治疗（PCI）组（n=50例）和经股动脉途径行PCI组（n=50例）。对比两组手术成功率、手术和曝光时间、平均住院时间、穿刺部位并发症和费用。结果经肱动脉途径和股动脉的手术成功率均为98．00％。两组的透视时间分别为（7．89±3．51）min和（7．88±3．43）min,手术时间分别为（42．9±9．2）min和（42．5±9．1）min,两组比较无统计学差异（P〉0．05）。与经股动脉途径组相比,经肱动脉组的穿刺部位并发症较低（P〈O．05）,平均住院时间较短（P〈O．05）,平均住院费用也较低（P〈O．01）。结论对于不适合经桡动脉途经治疗的复杂冠状动脉病变,可以首选经肱动脉途径PCI治疗。     

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。     

经桡动脉途径行冠状动脉介入治疗618例分析

目的:通过对比桡动脉、股动脉2种途径行冠状动脉介入治疗的临床疗效,探讨经桡动脉途径行冠状动脉介入治疗的安全性和有效性。方法:连续入选2003年12月至2009年12月在北京丰台医院心内科行冠状动脉介入治疗的患者1236例,随机分为桡动脉组618例,股动脉组618例,主要观察指标包括:手术成功率、穿刺成功率、血管开通时间、X线透视时间、手术总时间、不同指引导管的使用率、术中不良事件(包括死亡、急性心肌梗死、恶性心律失常、冠状动脉痉挛、夹层及穿孔和闭塞)、术后不良事件(包括死亡、急性心肌梗死、患侧肢体假性动脉瘤及血肿)及总住院时间等。结果:经桡动脉途径行冠状动脉介入治疗术的成功率为95.8%,与股动脉组比较,桡动脉组穿刺成功率、血管开通时间、X线透视时间、手术总时间差异无统计学意义。与股动脉组相比较,桡动脉组术后血肿的发生率、住院时间显著减少。结论:经桡动脉途径行冠状动脉介入治疗术安全有效,并发症少,减少了患者住院时间,但需要熟练掌握手术技巧,术中宜直接选择支撑力较好的指引导管,以提高手术成功率。     

三种不同路径行冠状动脉介入诊治的可行性和安全性的临床观察

目的 研宛经股动脉、桡动脉和尺动脉三种不同路径对冠状动脉介入的诊治方法,探讨经尺动脉径路行冠状动脉造影或介入治疗的可行性及安全性.方法 入选行冠状动脉造影及介入治疗的患者284倒,其中经尺动脉途径32例,经桡动脉途径168例,经股动脉途径91例,观察其手术成功率、失败原因和并发症.结果 冠状动脉介入诊治成功率,股动脉组100.0％,桡动脉组6.4％,尺动脉组96.9％.血管并发症发生率,股动脉组为(8.425±6.395)％,桡动脉组为(2.282±1.971)％,尺动脉组为(3.125±1.975)％.失败原因:3倒是因经桡动脉穿刺失败改尺动脉径路成功,3例桡动脉痉挛改尺动脉径路成功,1例尺动脉痉挛穿刺失败改股动脉穿刺成功.结论 经尺动脉路径行冠脉造影及介入治疗和经桡动脉径路一样是一种安全可行的介入诊疗路径.不仅可作为部分患者的首选穿刺血管,也可作为经桡动脉或股动脉途径的补充.     

经桡动脉途径介入治疗冠状动脉分叉病变的临床研究

目的:本研究通过对比桡、股动脉途径经皮冠状动脉(冠脉)介入治疗(PCI)冠脉分叉病变的成功率、手术即刻效果及患者的术后近、中期预后情况,探讨经桡动脉处理冠脉分叉病变的可行性和安全性.方法:研究共入选160例在我医院接受PCI的冠脉分叉病变患者,根据PCI的入路不同分为经桡动脉途径介入治疗组(桡动脉组)和经股动脉介入治疗组(股动脉组),对比两组患者接受PCI治疗的成功率、造影剂用量、手术时间以及并发症的发生率,并观察两组患者术后6个月时发生严重心脏不良事件(包括死亡、心肌梗死和靶病变血运重建等)和支架血栓的情况,同时在术后6个月时通过冠脉造影随访,比较两组患者支架再狭窄的发生率.结果:桡动脉组68例中仅1例患者因术中发生桡动脉痉挛而改为股动脉途径,最终有67例患者成功接受桡动脉治疗,桡动脉组的PCI成功率为98.5%.股动脉组中92例患者全部成功接受股动脉治疗.两组患者除性别、血脂方面,在其他临床特征上差异无统计学意义;在冠脉病变特征方面两组差异无统计学意义.PCI术中,桡动脉组83.6%患者选用的是6 F大腔导引导管(0.071英寸),股动脉组73.9%患者选用7 F导引导管,两组患者中单支架术处理的病变比例基本相近;在双支架处理的病变中,桡动脉组处理病变使用Balloon Crush技术多于股动脉组,差异有统计学意义(P<0.01),而在股动脉组中选择标准Crush技术处理病变则多于桡动脉组,差异有统计学意义(P<0.01).两组患者完成最终球囊对吻扩张的成功率差异无统计学意义(83.6%vs.79.3%).桡动脉组术后1例患者出现血管并发症,股动脉组患者中有6例患者出现了血管并发症.两组患者在术后6个月严重心脏不良事件的发生率差异无统计学意义(13.4%vs.11.9%),两组患者中均有1例患者出现支架血栓事件.术后6个月时冠脉造影随访:两组患者的主、边支再狭窄率无统计学意义.结论:相比于股动脉途径,桡动脉途径PCI分叉病变具有相似的成功率和临床效果,桡动脉途径PCI分叉病变具有良好的可行性和安全性.     

Case Report: A Rare Case of a Giant Right Coronary Artery Aneurysm

We report the case of a 34-year-old female patient with a giant thrombus-filled aneurysm of the right coronary artery presenting as a spherical cardiac mass on echocardiography. The cardiac mass was found to be an 8-cm right coronary artery aneurysm on cardiac magnetic resonance imaging, which also revealed a 3.5-cm proximal left coronary aneurysm and a very small aneurysm at the origin of the obtuse marginal coronary artery. Due to the extent and size of the right coronary aneurysm, a decision for surgical intervention was made. Resection of the right coronary artery aneurysm with vein graft replacement and a bypass to the left anterior descending followed by subsequent exclusion of the aneurysm was successfully performed.     

A Clinically Useful Coding System for Normal Coronary Artery Anatomy

Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50–70%, or greater than 70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.     

Spontaneous regression of post-percutaneous transluminal coronary angioplasty aneurysm

We report a case of a 67-year-old male with spontaneous regression of post-percutaneous transluminal coronary angioplasty (PTCA) aneurysm. This case substantiates the benign prognosis of post-PTCA aneurysms.     

Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the “normal” vessel

Seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a “normal” vessel. All patients had one or more episodes of rest angina and six had exertional angina as well. Four sustained previous myocardial infarction. During spontaneous angina, five patients had ST-segment elevation in the inferior electrocardiographic leads. One patient had ST-segment elevation in anterior leads. During angiography, spasm was demonstrated in the right coronary artery in three patients and in the left anterior descending coronary artery in one patient. This study emphasizes the interaction of fixed and vasospastic disease and has strong implications concerning the management of patients with ischemic heart disease.     

Coronary artery aneurysms

There is no consensus on the best management of coronary artery aneurysms (CAA) in adults. We describe two patients with CAA and review transcatheter approaches to exclude them from the circulation. © 2013 Wiley Periodicals, Inc.     

Anomalous right coronary artery arising from left mainstem

Various coronary artery anomalies occur in both symptomatic and asymptomatic individuals. We have described a unique case of an aberrant right coronary artery arising from the left mainstem, resulting in clinical myocardial infarction in the absence of coronary atherosclerosis. Though different anomalies of the right coronary artery have been described, we feel this case is unique in that the right coronary artery arises from the left mainstem, truly forming a single coronary artery.     

Anomalous origin of the right coronary artery from the left anterior descending: Angiographic diagnosis in a patient with coronary artery disease

The coronary angiographic findings of an individual whose right coronary artery originates from the proximal left anterior descending coronary artery are described.     

Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery

A rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.     

Left main stem coronary artery dissection during coronary angiography

This paper describes a case of dissection of the main stem of the left coronary artery during coronary angiography with an uneventful clinical course. As far as we know, only one comparable case has been reported before. A brief survey of the pertinent literature is presented. Some possible pathogenetic factors are considered. No specific preventive or therapeutic measurement can be recommended.     

Coronary artery-left ventricular communications: A report of two cases and review of the literature

Two patients with chest pain had angiographically-demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo-dynamic effect of the shunt flow than often suspected angiographically.