老年冠心病患者冠状动脉造影--经桡动脉通路与经股动脉通路对比研究

目的　评价经桡动脉通路冠状动脉造影 (TRCA)在老年患者的应用优势。方法　将 40 0例老年冠心病患者随机分为 TRCA组及经股动脉通路冠状动脉造影 (TFCA)组 (TFCA组 )。研究第一终点为进入通路失败 ,包括穿刺失败和导管送入途中失败 ;第二终点为临床过程结束 ,各观察指标收集完全 ,指标包括 :穿刺时间、导管到位时间、更换导管时间、透视时间、压迫止血时间和卧床制动时间 ,以及穿刺部位并发症和全身并发症 (血管迷走神经反射、腰背不适等 )。结果　两组穿刺成功率 TRCA组 96.5% ,TFCA组 97.5% ,导管送入成功率 TRCA组 97.9% ,TFCA组1 0 0 % ,平均穿刺时间、右冠脉导管到位时间、更换导管时间、透视时间 TRCA组略长于 TFCA组 (仅 0 .5 min左右 )。止血包扎时间 TRCA组 0 .93±0 .1 min,TFCA组 2 6.0 8± 8.43min(P<0 .0 0 1 )和肢体制动时间 TRCA组 2 .91± 0 .42 h,TFCA组 2 2 .4± 1 .55h(P<0 .0 0 1 )。并发症的发生率 TR-CA组明显低于 TFCA组 ,仅有 9.5%发生桡动脉痉挛 ,3.2 %术后前臂肌肉疼痛 ,继之桡动脉闭塞 ,但无手部缺血表现。 TFCA组发生皮下瘀血1 1 .3% ,假性动脉瘤 1 .0 3% ,血管迷走神经反射 8.2 % ,腰、背及下肢的酸痛不适 95.9%。两组无心脏事件发生。结论　经过一定的学习过程后 ,TR-CA     

经桡动脉介入治疗在急性冠脉综合征患者中的临床应用

目的观察急性冠脉综合征（ACS）患者经桡动脉人径行经皮冠状动脉介入治疗（PCI）的安全性及其疗效。方法选择2003年7有至2006年5月我院收治的157例临床诊断为急性冠脉综合征患者，分为经桡动脉穿刺冠状动脉成形术（TRCA）组71例和经股动脉穿刺冠状动脉成形术（TFCA）组76例。观察两组手术的成功率、介入治疗时间、并发症等。结果两组病例基本特征比较差异无统计学意义。TRCA组与TFCA组插管成功率比较差异无统计学意义（97．2％比98．6％，P〉0．05）。从穿刺到指引导管撤出时间，TRCA组为（51．2±18.3）min，TFCA组为（46．7±16．9）min，两组比较差异无统计学意义（P〉0．05）。术后与穿刺相关的并发症，TRCA组出现桡动脉痉挛2例，局部血肿1例。TFCA组出现局部血肿3例，迷走反射5例，假性动脉瘤1例，排尿困难6例，腰痛4例。结论对ACS患者，两种人径的PCI治疗时程和效果相似，但TRCA治疗血管、出血、血栓／栓塞并发症少，且有利于有效安全的抗凝治疗，可作为ACS可选择的血管途径之一。     

76例老年患者经桡动脉穿刺冠状动脉成形术临床观察

目的　探讨老年人经桡动脉穿刺冠状动脉成形术的安全性及成功率。　方法　老年组76例 ,对照组 15 4例 ,2组患者均首选经桡动脉穿刺冠状动脉成形术 ,对比观察其成功率、并发症、手术时间、X线照射时间及造影剂用量等。　结果　老年组桡动脉穿刺及插管成功率为 94 7%,冠脉成形术成功率为 93 3%,并发症发生率为 5 3%;对照组分别为 97 4 %、94 1%、5 2 %,2组间差异均无显著性 (P >0 0 5 ) ;手术时间、X线照射时间及造影剂用量分别为 (30 5± 12 5 )min与 (2 9 5± 11 6 )min、(2 0 6± 5 8)min与 (19 3± 7 5 )min、(90 8± 2 0 3)ml与 (89 4± 2 1 9)ml,2组之间差异均无显著性 (P >0 0 5 )。　结论　对于桡动脉搏动好、Allen试验无缺血、不需要大直径旋磨导管旋磨及定向斑块旋切技术治疗的老年患者 ,经桡动脉穿刺冠状动脉成形术安全、有效。     

经肱动脉穿刺冠状动脉腔内成形术278例临床观察

目的探讨经肱动脉穿刺冠状动脉腔内成形术的安全性及成功率.方法经肱动脉穿刺冠状动脉成形术(TBCA)组278例,采用经右侧肱动脉穿刺途径.经股动脉穿刺冠状动脉成形术(TFCA)组144例,采用经右侧股动脉穿刺途径.观察两组手术的成功率、并发症等.结果两组穿刺插管及冠状动脉成形术成功率分别为94.2% 与100% 及92.3% 与94.3%,两组间P＞0.05.两组并发症分别为5.8%与5.6%,P＞0.05.术后持续卧床时间两组分别为0与(11.4±4.6)h,有显著差异(P＜0.001).结论经肱动脉穿刺冠状动脉成形术安全、有效,不影响术后患者活动.     

经桡动脉穿刺老年冠状动脉成形术76例临床分析

为探讨经桡动脉穿刺老年冠状动脉成形术的安全性及成功率,设老年组(76例)和对照组(154例)进行比较.结果老年组桡动脉穿刺及插管成功率为94.7%,冠脉成形术成功率为93.3%,并发症发生率为5.3%;对照组分别为97.4%、94.1%、5.2%,两组间均无显著性差异(P＞0.05).其手术时间、X线照射时间及造影剂用量分别为30.5±12.5与29.5±11.6min、20.6±5.8与19.3±7.5min、90.8±20.3与89.4±21.9ml,两组之间均无显著差异(P＞0.05).提示对于桡动脉搏动好、Allen试验无缺血、不需要大直径旋磨导管旋磨及定向斑块旋切技术治疗的老年患者,经绕动脉穿刺冠状动脉成形术安全、有效.     

经肱动脉穿刺老年冠状动脉成形术106例临床观察

目的　探讨经肱动脉穿刺老年冠状动脉成形术的安全性及成功率。方法　老年组 10 6例 ,对照组 172例 ,两组患者均首选经右侧肱动脉穿刺冠状动脉成形术。观察手术成功率、并发症、手术时间、X线照射时间及造影剂用量等。结果　老年组肱动脉穿刺及插管成功率为 93 4% (99/10 6 ) ,冠状动脉成形术成功率为 91 8% (16 8 183) ,并发症发生率为 5 7% (6 /10 6 ) ;对照组肱动脉穿刺及插管成功率为 94 8% (16 3/172 ) ,冠状动脉成形术成功率为 92 6 % (2 6 2 /2 83) ,并发症为 5 8% (10 /172 )。两组间无显著性差异 (P >0 0 5 )。手术时间 (分 )、X线照射时间 (分 )及造影剂用量 (毫升 )分别为 2 9 5±11 6min与 2 8 6± 10 5min、18 8± 5 5min与 18 6± 5 8min、90 6± 2 1 6ml与 90 4± 2 0 8ml,经统计学处理 ,两组之间均无显著差异 (P >0 0 5 )。结论　经肱动脉穿刺老年冠状动脉成形术安全、可行。     

经皮桡动脉冠状动脉造影及冠状动脉成形术的临床应用

目的 :评价经皮桡动脉冠状动脉造影术与冠状动脉腔内成形术 (PTCA)的临床应用价值。方法 :有选择性的对 37例患者行经皮桡动脉途径冠状动脉造影及冠状动脉成形术 ,观察其疗效和血管并发症。结果 :1 桡动脉穿刺成功率为 93 8% (有 2例失败 )。 2 14例冠状动脉造影正常 ,17例冠状动脉造影显示 2 6处存在≥ 70 %的狭窄病变 ,适合行冠状动脉介入手术。 2 6处病变有 4处PTCA疗效满意 ,2 2处行PTCA +支架术 ,植入支架 31只。狭窄从 (81± 12 ) %降低至 (10 6± 7 4 ) % ,最小血管直径由 (0 86± 0 12 )mm增加至 (3 0 8± 0 32 )mm。 6例病人行冠状动脉旁路移植术。 3 所有患者术后即拔导管鞘 ,局部压迫 4h。术后并发症的发生率为 3 3% (1例术后的桡动脉闭塞 )。结论 :经桡动脉途径行冠状动脉造影及冠状动脉成形术安全可行 ,其具有穿刺部位出血少、住院时间短的特点 ,可选择性的应用于某些冠心病患者。     

经桡动脉经皮冠状动脉腔内形成术

目的　评价经桡动脉途径经皮冠状动脉腔内成形术 (PTCA)的临床应用价值。方法有选择性对 30 6例患者经桡动脉途径行PTCA ,观察其疗效和血管并发症。结果　 (1)桡动脉穿刺成功率为 97 5 %。 (2 )对 30 6例 412处病变行PTCA ,成功率为 98 3%。于 2 44例 317处病变成功植入支架 332只。狭窄从 (76± 12 ) %降低至 (12± 10 ) % ,最小血管直径由 (0 8± 0 3)mm增加至 (2 9± 0 4)mm。 (3)所有患者术后即拔导管鞘 ,局部压迫 3～ 5h。并发症发生率为 4 9% ,其中最常见并发症为术后桡动脉闭塞 (3 9% )。结论　经桡动脉途径PTCA安全可行 ,可选择性应用于某些冠心病患者 ,其穿刺部位出血并发症少、住院时间短等优点。     

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。     

经桡动脉和股动脉途径行冠状动脉造影的对比研究

目的探讨经桡动脉和股动脉造影的优缺点。方法2002年10月~2004年4月住院并行冠状动脉造影患者112例,按桡动脉和股动脉途径分为两组,对比观察其X线照射时间、手术操作时间、成功率、并发症发生率。结果经统计学处理,X线照射时间分别为(6.12±3.54)min和(5.80±3.64)min(P>0.05),手术操作时间分别为(20.10±10.36)min和(19.82±10.44)min(P>0.05),成功率分别为98.07%和100%(P>0.05),血管并发症分别为3.84%和17.3%(P<0.01)。结论经桡动脉途径行冠状动脉造影不需卧床,患者损伤小,止血方便,血管并发症少,是一种安全、有效的途径。     

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.     

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.     

Sudden coronary death

Many reports have described the amounts of atherosclerotic plaque in victims of sudden coronary death, defining the number of coronary arteries narrowed at some point greater than 75% in cross-sectional area (XSA). In order to quantitate more precisely the amount and distribution of plaque, 70 victims of sudden coronary death aged 22-81 years (mean 50) were studied. The four major epicardial coronary arteries (left main, left anterior descending, left circumflex, and right) from each of 70 victims were cut into 5-mm segments (average 50 per patient) and a histologic section prepared from each segment. The amount of luminal narrowing by plaque was categorized into five groups (0-25%, 26-50%, 51-75%, 76-95%, 96-100%). Of 3,484 five-mm segments, 950 (27%) were narrowed 76-100% in XSA. Comparison of 31 previously symptomatic victims (angina pectoris and/or myocardial infarction) to 39 victims who had been asymptomatic disclosed a higher mean percent of severely narrowed segments (30% vs. 25%, p = less than 0.005) and a lower mean percent of minimally narrowed segments in the symptomatic group. Comparison of the 31 patients with a healed myocardial infarction at necropsy with 39 patients with no left ventricular scar disclosed a higher mean percent of segments severely narrowed (33% vs. 24%, p = less than 0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13% vs. 26%, p = less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty-two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals. All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

The incidence of coronary anomalies on routine coronary computed tomography scans

The incidence of coronary anomalies (CCAs) in a typical angiographic study was 1.3%.1 Studies have been conducted on CCAs using conventional invasive coronary angiography in highly selected groups of patients but these studies may not reflect the true incidence of CCAs.Although the majority of CCAs are benign and incidentally detected during conventional angiography, certain CCAs may cause syncope, heart failure or sudden death, especially among young athletes.2,3 The US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry found that CCAs were the second most common cause of sudden cardiac death (out of 17% of the population who died of cardiac-related causes).4Although conventional invasive coronary angiography is considered the gold standard for the diagnosis of CCAs, transthoracic two-dimensional echocardiography, transoesophageal echocardiography, magnetic resonance imaging and multi-slice computed tomography (MSCT) can all identify for diagnosis, CCAs in certain groups of patients.5-10 Transthoracic twodimensional echocardiography may depict the origin of the coronary arteries, especially the left main artery, but successful detection of coronary anomalies depends on the age and size of the patient.5,6Transoesophageal echocardiography has an increased success rate of identifying coronary anomalies in comparison with two-dimensional echocardiography. Nevertheless, the position of the transducer, cardiac motion, and the curvilinear course of the vessel all affect visualisation of coronary anomalies. Moreover, transoesophageal echocardiography is a semi-invasive method and is time consuming.6,7Magnetic resonance (MR) imaging provides an accurate assessment of the course of anomalous coronary arteries.8,9 However, this technique cannot be performed in patients with pacemakers, certain types of arrhythmias or defibrillating devices, and it may be difficult to perform in claustrophobic patients. Furthermore, the spatial resolution of MR imaging is substantially inferior to that of the newest generation of CT scanners.10Myocardial bridging (MB) is defined as the compression of a coronary artery during systole while it is normal in diastole. MB has been linked to serious cardiac events.11 The incidence of myocardial bridging in the population varies substantially according to invasive coronary angiography (13%) and autopsy (15–85%).12,13 The reported incidence of MB has increased up to 44% when using 64-MSCT.14 Because of its ability to cause serious cardiac events, diagnosing MB is clinically important.MSCT is a minimally invasive method that provides excellent temporal and spatial resolution of the coronary arteries. There have been a limited number of studies evaluating CCAs and MB with 64-MSCT. The aim of this study was to assess the incidence of CCAs and MB using 64-MSCT in a relatively large population.     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

The disappearing coronary stenosis: reemphasizing the importance of excluding coronary vasospasm before coronary intervention.

We describe a case of resting angina with multiple angiographic stenoses that were highly suitable for stenting. These classic lesions resolved after intracoronary nitroglycerin while positioning a stent. This case reemphasizes the need to exclude vasospasm prior to any interventional coronary procedure.     

Percutaneous transluminal coronary angioplasty of a right coronary artery arising from the left main coronary artery

Angioplasty of anomalous coronary arteries presents unique technical challenges. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and to provide support to cross the lesion. A case of successful PTCA of a lesion in an anomalous right coronary artery arising from the left main coronary artery is presented. © 1993 Wiiey-Liss, Inc.