经桡动脉冠状动脉成形和支架置入术165例临床体会

目的 探讨经桡动脉进行冠状动脉成形和支架置入手术的可行性和安全性.方法 回顾2007年1月至2011年9月在我院住院的165例冠心病患者进行经桡动脉冠状动脉成形和支架置入手术的病例资料.结果 165例患者中,162例完全由桡动脉途径完成,3例为联合或改行股动脉途径完成,桡动脉途径成功率98.18%.1例发生轻度出血,桡动脉途径并发症发生率为0.0061%.结论 经桡动脉行冠状动脉成形和支架置入术,可以作为基层医院行冠心病介入手术的安全途径.     

经桡动脉导管反折技术完成颈部动脉血管造影及介入治疗的可行性分析

目的:探讨一种新的经桡动脉完成颈部动脉血管造影检查及介入治疗方法的安全性和可行性。方法:2015年至2017年期间,选择通过桡动脉路径利用指引导管反折技术顺向进入颈部血管的方法完成颈部动脉血管造影及治疗的患者33例,男性30例,年龄53～85(68.8±6.2)岁,高血脂症患者30例。探讨手术的成功率及并发症。结果 :33例患者成功经桡动脉路径完成颈部动脉血管造影检查,颈动脉狭窄70%的患者16例,均完成靶血管支架置入17枚,支架长度16～40(33.8±8.7) mm;支架直径3.5～9.0(7.4±1.9)mm;其中6例患者术中出现暂时性窦性心动过缓,2例出现短暂性血压下降,予以对症治疗后好转,均无不良后果,未出现继发脑梗死、桡动脉闭塞等术后并发症。且术后患者能即刻行走自如。结论:经桡动脉利用指引导管在主动脉窦部反折顺向行颈部血管检查、治疗是方便、安全可行的。     

经桡动脉行颈动脉狭窄支架成形术的疗效分析

目的 探讨经桡动脉入路行颈动脉狭窄支架成形术的适应证和优势。方法 经桡动脉入路在颈内动脉岩部放置阻塞球囊，对38例颈动脉粥样硬化性狭窄患者行支架置人术。其中有症状者29例，无症状者9例。术前均行颈动脉数字减影血管造影（DSA）、脑实质血管DSA、颈动脉多普勒超声及头部MRI等检查。结果 术后患者均复查颈动脉DSA和脑实质血管DSA，显示脑部供血均有明显改善，其患侧颈内动脉、皮质下血管显影时问较术前提前0．3～0．8S，颅内血管血流经过时间缩短0．4～0．7s。短暂性脑缺血发作（TIA）症状消失。全组无手术死亡病例，无并发症。随访3～15个月，无再狭窄患者。结论 当经股动脉入路为相对禁忌时，经桡动脉入路是颈动脉狭窄支架成形术值得选择的一种入路。     

经桡动脉行冠脉造影及支架置入术的护理体会

目的分析经桡动脉行冠脉造影与支架置入术治疗患者的临床护理方法与效果,以便为临床提供参考。方法将我院2011年4月~2013年4月接诊的经桡动脉行冠脉造影与支架置入术治疗患者231例作为研究对象,回顾性分析他们的临床资料,总结临床护理方法与效果。结果本次研究231例患者皆顺利完成手术治疗,术中未出现严重并发症患者,桡动脉穿刺成功率高达98.70%(228/231);术后出现并发症3例,包括1例急性心肌缺血、1例栓塞及1例桡动脉穿刺手部缺血,而并未出现心脏事件与桡动脉搏动消失等并发症;本组患者治疗与护理后血液流动学指标相较于治疗前皆有明显改善,对比差异性显著(P0.05),有统计学意义;术后住院时间均值为(8.4±1.2)天,皆痊愈出院。结论针对经桡动脉行冠脉造影与支架置入术治疗患者,做好心理护理与健康宣教,同时做好围手术期的护理,包括皮肤护理、术中观察,术中与术后并发症护理等,可以改善并发症的发生情况,提高患者生存质量,值得临床借鉴。     

经桡动脉行冠状动脉介入治疗的临床分析和疗效观察

目的：探讨在临床工作中,经桡动脉途径行冠状动脉介入治疗（TRI）的优势以及可行性。方法对在2011年2月~2014年2月期间,我院收治的112例需行冠脉介入治疗（TRI）的患者的临床资料进行比对、分析,观察患者的手术成功率以及并发症。结果经桡动脉途径行冠状动脉介入治疗（TRI）,穿刺成功有110例,成功率为98.21％,而术后并发症：桡动脉发生痉挛3例,术后穿刺部位出现小血肿有1例,前臂出现肿胀有1例,血管迷走痉挛1例,共有6例,并发症发生率为5.3％。结论经桡动脉途径行冠状动脉介入治疗（TRI）,效果确切、安全性高、并发症较少,值得在临床推广。     

颈内动脉肌纤维发育不良患者的DSA诊断和治疗

目的探讨颈动脉肌纤维发育不良（FMD）患者的临床特征、诊断及治疗。方法从南京卒中注册系统中检索出2010年5月—2011年5月的6例颈动脉肌纤维发育不良患者,提取这些患者的临床表现、实验室检查和影像学检查、治疗和随访结果等资料。6例FMD患者中1,例合并颈内动脉闭塞,1例合并大脑中动脉闭塞,2例合并夹层动脉瘤。对本组患者的治疗措施有,单纯给予3例患者抗血小板聚集药物治疗;1例患者因合并烟雾病未行抗血小板聚集治疗,只进行对症治疗;2例患者接受颈动脉支架置入及药物治疗。结果①6例FMD患者均经DSA确诊,均有颈内动脉管壁不规则或串珠样改变4,例患者表现为双侧FMD,2例表现为左侧FMD;②给予相应治疗后,6例患者均未出现新发症状,原有症状缓解,2例接受颈内动脉支架置入术的患者,术后均无残余狭窄。③3个月随访均未见缺血事件发生。接受支架置入术的患者,术后6个月复查DSA,支架形态良好,无再狭窄。结论 FMD患者可合并颈内动脉闭塞或颈内动脉夹层动脉瘤。血管内成形术可作为目前有效且安全的治疗方法之一。     

经桡动脉入路行颈动脉狭窄支架植入术的安全性和可行性

颈动脉狭窄支架植入术的常规入路分为桡动脉入路和股动脉入路。桡动脉入路具有穿刺口并发症少, 患者舒适度增加和术后制动时间短等优点, 越来越多的介入医师倾向选择经桡动脉入路行介入治疗。但目前这两种途径的优先选择仍有争议, 因此我们旨在回顾经桡动脉对比经股动脉途径行颈动脉支架植入手术的文献, 来阐明经桡动脉入路在安全性和可行性上的优势。     

经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的临床研究

目的探讨经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄的有效性和安全性。方法选择老年症状性椎动脉狭窄患者45例,行经桡动脉途径椎动脉支架成形术,观察其手术成功率、围术期并发症及临床疗效。结果 45例患者中,椎动脉开口置入球扩式支架43枚,椎动脉颅内段置入自膨式支架2枚,术后即刻造影,残余狭窄<20%,技术成功率达100%。围术期未发生动脉夹层、支架内血栓形成、颅内出血等并发症。与术前比较,术后临床症状明显好转,术后2～7d血流动力学明显改善(P<0.01)。总有效率93.3%。术后随访3个月～4年,平均(24±8)个月,支架内再狭窄12例(26.7%),无与责任血管相关的短暂性脑缺血发作及后循环脑梗死发生。结论经桡动脉途径血管内支架成形术治疗老年症状性椎动脉狭窄临床疗效好,并发症少,是一种安全有效的治疗方法。     

经桡动脉行冠状动脉斑块旋磨和药物支架置入术治疗严重钙化病变的安全有效性

目的:探讨经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,治疗严重钙化病变的临床效果。方法:回顾性分析我院2010年1月至2011年1月,经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,冠心病患者的89例临床资料。并分析其手术特点、并发症及主要不良心血管事件(包括全因死亡、非致死性心肌梗死、靶血管血运重建)。结果:89例(100%)患者均成功经桡动脉行冠状动脉斑块旋磨术,并置入药物洗脱支架。术中共有8例(9.0%)患者发生并发症,经处理后取得良好的效果。术后随访(22.21±4.73)个月,主要不良心血管事件的发生率为12.4%。结论:经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,治疗严重钙化病变是一种安全、有效的治疗方法。     

高危患者颈动脉支架手术并发症的预防及临床分析

目的总结高危患者颈内动脉支架术可能出现的并发症,进行预防及相关处理,减轻临床症状。方法回顾性分析我科2006年4月～2011年3月59例（63支颈动脉）高危颈内动脉支架植入术患者临床资料。结果手术成功率100%,合计植入支架65枚,并发症包括血压心率一过性下降23例;术中栓塞事件3例,死亡1例;癫痫大发作1例;支架移位再次植入支架2例;动脉夹层2例;股动脉假性动脉瘤3例;同侧颈外动脉闭塞1例;随访远期再狭窄2例。结论对于高危患者颈动脉支架术是安全的,对于术中可能出现的危险因素积极采取预防措施以及术后全程监测,是减少并发症的关键。     

Contralateral transradial approach for carotid artery stenting: A feasibility study

Background : Carotid artery stenting (CAS) has become an accepted modality of treatment for revascularization of the internal carotid artery (ICA). CAS from femoral approach has got wide acceptance, however, it can be problematic due to access site complication as well as technical difficulties related to peripheral vascular disease and/or anatomical variations of the aortic arch. Small feasibility studies of CAS through ipsilateral transradial approach have been described in the literature. The purpose of the present study is to evaluate the feasibility of contralateral transradial approach as an alternative approach for CAS. Methods : Twenty patients (mean age: 65 ± 5, 17 male) underwent CAS using contralateral transradial approach. All had a CA stenosis greater than 80%. The target common carotid artery (CCA) was initially cannulated via the contralateral radial artery using a 5F Simmons 1 diagnostic catheter or a 5F TIG diagnostic catheter, which was then advanced to the external CA (ECA) over an exchange length of 0.032″ Terumo Glidewire or a 0.025″ Glidewire. Once the catheter was parked in the optimal position in ECA, the wire was removed and was replaced by 0.035″ Amplatz Super stiff Guide wire. Following that, the Simmons 1 or the TIG catheter was removed and 6F Pinnacle Sheath was exchanged and positioned in the distal CCA. CAS was performed using standard techniques with weight‐based heparin for anticoagulation. Results : CAS was successful in 16/20 (80%) patients, including 12/12 (100%) right CA, 4/8 (50%) left CA. Mean interventional time was 40 ± 5 min. The sheath was removed immediately after the procedure. There were no radial access site complications. One patient sustained a transient ischemic attack and recovered completely with complete resolution of symptoms within 1 hr. Median Hospital stay was 3 ± 0.5 days. Angulation of left CCA with the aortic arch was the technical cause of failure in the four unsuccessful cases. Conclusion : CAS using the contralateral transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions because of the favorable right CCA angle with the aortic arch. © 2009 Wiley‐Liss, Inc.     

Transradial approach for carotid artery stenting: a feasibility study.

BACKGROUND: Carotid artery stenting (CAS) has become accepted as an alternative to carotid endarterectomy for revascularization of the internal carotid artery (ICA) among high risk patients. CAS from the femoral approach can be problematic due to access site complications as well as technical difficulties related to peripheral vascular disease (PVD) and/or anatomical variations of the aortic arch. The purpose of the present study is to evaluate the feasibility of the radial artery as an alternative approach for CAS. METHODS: Forty-two patients (mean age 71 +/- 1, 26 male) underwent CAS. All had a CA stenosis greater than 80% and comorbid conditions increasing the risk of carotid endarterectomy. The target common carotid artery (CCA) was initially cannulated via the radial artery using a 5F Simmons 1 diagnostic catheter which was then advanced to the external CA (ECA) over an extra support 0.014" coronary guidewire. After removing the coronary guidewire, a 0.035" guidewire was advanced into the ECA, and the Simmons 1 was exchanged for a 5F or 6F shuttle sheath and positioned in the distal CCA. In four patients with a bovine aortic arch, the left CCA was accessed with a 5F Amplatz R2 catheter which was then exchanged for a shuttle sheath over a 0.035" guidewire. CAS was performed using standard techniques with weight-based bivalirudin for anticoagulation. RESULTS: CAS was successful in 35/42 (83%) patients, including 28/29 (97%) right CA, 4/5 (80%) bovine left CA, 7/13 (54%) left CA. Mean interventional time was 30 +/- 3 minutes. The sheath was removed immediately after the procedure. There were no radial access site complications. One patient sustained a stroke 24 hrs after the procedure with complete resolution of symptoms (Mean NIH stroke scale 2.0 +/- 0.3 before, 1.9 +/- 0.3 after). Median hospital stay was 2 +/- 0.6 days. Inadequate catheter support at the origin of the CCA was the technical cause of failure in the seven unsuccessful cases. CONCLUSION: CAS using the transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions and severe PVD or unfavorable arch anatomy, and among patients with a bovine aortic arch.     

Feasibility and safety of transbrachial approach for patients with severe carotid artery stenosis undergoing stenting.

Although sporadic successful cases using the transradial approach (TRA) for carotid stenting have been reported, the safety and feasibility of carotid stenting using either TRA or a transbrachial approach (TBA) have not been fully investigated. Recently, we have developed a safe and feasible method of TRA for cerebrovascular angiographic studies. This study investigated whether a TBA approach using a 7-French (F) Kimny guiding catheter for carotid stenting is safe and feasible for patients with severe carotid stenosis. Thirteen patients were enrolled into this study (age range, 63-78 years). Seven of these 13 patients had severe peripheral vascular disease. A retrograde-engagement technique, involving looping 6-F Kimny guiding catheter, was utilized for carotid angiographic study. For carotid stenting, the 6-F Kimny guiding catheter was replaced with a 7-F Kimny guiding catheter, and the procedure was performed as the follows. First, an extra-support wire was inserted into the middle portion of external carotid artery (ECA). Second, a 0.035-inch Teflon wire was advanced into the common carotid artery. Then, the 6-F guiding catheter was exchanged for a 7-F Kimny guiding catheter. Third, if the first and second steps did not provide adequate support for exchanging the guiding catheter, a PercuSurge GuardWire was inserted into the ECA, followed by distal balloon inflation for an anchoring support. FilterWire EX was used in 9 patients and PercuSurge GuardWire in 4 patients to protect from distal embolization during the procedure. The procedure was successful in all patients. No neurological or vascular bleeding complications were observed and all patients were discharged uneventfully. The TBA for carotid stenting was safe and effective, providing a last resort for patients unsuited to femoral arterial access and surgical intervention.     

颈动脉术后再狭窄的支架置入疗效分析

目的评价颈动脉支架置入术(CAS)治疗颈动脉术后再狭窄病变的临床疗效。方法回顾性分析首都医科大学宣武医院神经外科支架置入治疗的颈动脉内膜切除术(CEA)或CAS后再狭窄的19例患者,均为男性,年龄为48~78岁,平均(61.5±8.6)岁。其中CAS后再狭窄9例,CEA后再狭窄10例,均经DSA确诊,并行CAS治疗再狭窄,术前及术后第2天均行颈动脉彩色多普勒血流显像检查,术后1、3、6、12个月门诊随访。结果对19例患者均成功置入支架,未出现并发症,残余狭窄率均20%。术后患者自觉神经缺损症状消失。术后各时间点随访均未发现心肌梗死、卒中及死亡事件。随访终点时患者均无临床症状,复查颈动脉彩色多普勒血流显像均未显示再狭窄。结论 CAS治疗颈动脉术后再狭窄可能是一种安全有效的方法。     

Transradial approach for stenting of vertebrobasilar stenosis: A Feasibility Study

Background: Endovascular intervention of vertebrobasilar stenosis is a relatively new but alternative modality of management, supported by very few studies and case reports. Femoral approach has been used in all. The purpose of present study is to evaluate feasibility of the radial artery as an alternative approach for vertebral artery stenting (VAS) and basilar artery stenting (BAS). Methods: Forty‐seven patients (mean age 70 ± 5, 38 male) underwent VAS and BAS. VAS was offered in 42 and BAS was offered in five patients. All the patients were symptomatic having stenosis greater than 75%. The target vertebral artery (VA) was cannulated using a 6Fr Internal Mammary Artery (IMA) guide catheter using ipsilateral radial approach. 0.014″ floppy tip coronary guide wire was advanced and parked across the culprit stenosis. Pre dilation was done using a 2 × 12 mm² or a 2.5 × 12 mm² PTCA catheter and balloon mounted 2.5 × 13 mm² or 3 × 13 mm² bare metal stent was deployed using 8–10 atm pressure for all chronic lesions. For acute occlusions, the procedure was divided in two stages. In first stage, the lesion was dilated using PTCA catheter (1.5 × 12 mm²) at 4–6 atm pressure just to establish the distal flow. After 24 hr, the patient was brought back and the culprit lesion was stented using 8–10 atm pressure. The procedure was staged to prevent hyperperfusion brain injury. Results: VAS was successful in 42/42 (100%) patients. BAS was successful in five out of five (100%) patients. However, three patients had transient periprocedural stroke which recovered completely within 6 hr and one patient developed intracerebral hemorrhage (ICH) who died after 24 hr. Hyper perfusion brain injury was the cause for ICH. Conclusion: VAS and BAS using the transradial approach appear to be safe, technically feasible, and reproducible. Technical ease of cannulation of vertebral artery with IMA guide catheter using ipsilateral transradial approach should make it more convenient when compared with femoral approach.© 2009 Wiley‐Liss, Inc.     

Protected carotid artery stenting in patients with severe stenosis

Intraplaque hemorrhage (IPH) and ulcers are the major findings of unstable plaques. In addition, initial symptoms are associated with postprocedural complications after carotid artery stenting (CAS). The aim of this study was to determine the safety of CAS using an embolic protection device in symptomatic patients with severe carotid artery stenosis and unstable plaques such as IPH and ulcers.This retrospective study included 140 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid vessel wall imaging to evaluate the plaque status. We analyzed the incidence of initial clinical symptoms, such as headache, nausea, and vomiting, after CAS. The primary outcomes analyzed were the incidence of stroke, myocardial infarction, and death within 30 days of CAS.Sixty-seven patients (47.9%) had IPH, and 53 (38.9%) had ulcers on carotid wall imaging/angiography. Sixty-three patients (45.0%) had acute neurological symptoms with positive diffusion-weighted image findings. Intraluminal thrombi on initial angiography and flow arrest during CAS were significantly higher in patients with IPH and symptomatic patients. Symptoms were significantly higher in patients with IPH than in those without (63.5% vs 35.1%, P < .001). There were no significant differences in clinical symptoms after stenting or in primary outcomes, regardless of IPH, ulcer, or initial symptoms.IPH and plaque ulceration are risk factors in symptomatic carotid stenosis. However, IPH and plaque ulceration were not a significant risk factors for cerebral embolism during protected carotid artery stent placement in patients with carotid stenosis. Protected CAS might be feasible and safe despite the presence of unstable plaques.     

Transulnar carotid artery stent placement

Carotid artery stenting (CAS) has increased in popularity as an alternative to carotid artery endarterectomy for the treatment of significant carotid artery stenosis. The access site is predominantly the femoral artery, with radial or brachial access used less often. Here, we describe a case of CAS after failure of brachial access. Transulnar CAS was performed successfully without complications. Transulnar access represents an additional option in a patient undergoing CAS when conventional femoral, brachial, and radial arteries are not applicable. © 2012 Wiley Periodicals, Inc.     

使用MPA导管经桡动脉行双侧颈动脉造影方法可行性探讨

目的研究经桡动脉途径行双侧颈动脉选择性造影新的常规造影方法。方法对广东省人民医院2011年1月至2011年3月期间32例经桡动脉应用MPA造影导管行双侧颈动脉选择性造影患者进行回顾性分析。结果桡动脉穿刺成功率100%,经桡双侧颈动脉选择性造影成功率100%,无并发症发生。结论本方法行双侧颈动脉选择性造影操作可行、安全,可做为常规颈动脉造影方法。     

Transradial carotid stenting in a patient with bovine arch anatomy

Carotid stenting in difficult arch anatomy can be safely done by transradial route depending upon operator's experience. Left carotid artery stenosis with Bovine arch anatomy can be approached by right arm approach (radial/brachial) easily. In cases with Bovine arch anatomy, left arm approach by modified looping technique is still possible. We report a case of carotid stenting in a patient with bovine arch anatomy using percusurge anchoring technique through left radial approach. © 2010 Wiley‐Liss, Inc.     

经桡动脉途径肾动脉狭窄介入治疗的初步经验

目的探讨经桡动脉途径行肾动脉狭窄介入治疗的安全性和有效性。方法自2010年10月至2011年2月,入选6例经桡动脉途径行肾动脉介入治疗的患者,桡动脉穿刺使用6Fr桡动脉鞘系统（Terum o,Japan）,止血使用桡动脉止血带（Terumo,Japan）,选择性肾动脉造影使用5FrMPA120cm造影管（COOK,USA）,肾动脉支架术使用PCI（percutaneous coronary intervention,PCI）导丝、6FrMPA1 125cm指引导管（Cordis,USA）及肾动脉支架系统。结果肾动脉造影示：4例患者单肾动脉狭窄,2例患者双肾动脉狭窄。6例患者均经桡动脉途径行肾动脉介入治疗成功,无中转股动脉途径,技术成功率达100%。穿刺口恢复良好,无穿刺部位血肿、假性动脉瘤等发生。介入治疗时间（35±4.6）m in,造影剂（典必乐）用量（82.5±7.7）m l,止血时间（4.1±1.1）m in。结论经桡动脉途径行肾动脉狭窄介入治疗技术可行、创伤小、恢复快、并发症少,可能成为肾动脉狭窄介入治疗的另一途径。