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.     

Comparison of 5 French versus 6 French guiding catheters for transradial coronary intervention: a prospective, randomized study

We compared 5 versus 6 French (Fr) guiding catheters in coronary intervention using the transradial approach. Smaller guiding catheters may have advantages over larger ones in transradial coronary intervention. However, there is uncertainty about how small is small enough, and when smaller would become too small. Eligible patients were randomized between the 5 and 6 Fr groups before the procedure. The primary endpoint was procedural success. A total of 216 patients were randomized. Procedural success was obtained in 95% of the 6 Fr group versus 90% of the 5 Fr group (p = 0.25). Most of the failures in the 5 Fr group were because of cross-over to the 6 Fr group. Crossover to the 5 Fr group occurred in 1 patient in the 6 Fr group (0.9%; p = 0.05) because of a small radial artery. Transradial intervention using 5 Fr guiding catheters necessitates crossover to a 6 Fr catheter in 6.8% of cases, and offers no clear advantages over the 6 Fr technique.     

New method to increase a backup support of a 6 French guiding coronary catheter.

A 6 Fr guiding catheter is commonly used in the percutaneous coronary intervention (PCI). However, one of the limitations of the 6 Fr guiding catheter is its weak backup support compared to a 7 or an 8 Fr guiding catheter. In this article, we present a new system for PCI called the five-in-six system. Between March 2003 and September 2003, this system was tried on eight chronic total occlusion cases. The advantage of the five-in-six system is that it increases backup support of a 6 Fr guiding catheter.     

Five French versus 6 French PCI: a case control study of efficacy,safety and outcome

We report our experience of percutaneous coronary intervention (PCI) with 5 French (Fr) guiding catheters in a retrospective analysis of consecutive cases undergoing ad hoc PCI. Results were compared with a cohort of 6 Fr PCI cases matched for age, sex and operator over the same study period. A total of 210 patients (311 lesions) underwent PCI using 5 Fr guiding catheters and 174 matched patients (300 lesions) underwent PCI with 6 Fr guiding catheters. Multivessel PCI was performed in 18% of patients in the 5 Fr group and in 26% of the 6 Fr group (p = 0.046). There was no difference in clinical, angiographic or procedural characteristics between groups. Technical success rate was superior in the 5 Fr group compared with the 6 Fr (99% versus 95%; p = 0.03). The rate of stent implantation did not differ and the 5 Fr guiding catheter did not prohibit the use of large or long stents/balloons. Failure of 5 Fr PCI in 3 cases was not due to inadequate guiding catheter support. In-hospital major adverse cardiac events (MACE) and serious femoral complications were rare and at 6-month follow-up did not differ between groups. However, compared with 6 Fr PCI, procedure time and contrast medium usage was significantly less in the 5 Fr group (contrast: 274 +/- 101 ml versus 313 +/- 124 ml; p = 0.0008; fluoroscopy time: 16 +/- 9 minutes versus 19 +/- 12 minutes; p = 0.006). We conclude that the use of 5 Fr guiding catheters is effective and safe in unselected patients undergoing PCI and may even confer certain advantages. The 5 Fr approach can be recommended for routine interventional practice.     

Balloon assessment of patent foramen ovale morphology and the modification of tunnels using a balloon detunnelisation technique

Background: Percutaneous coronary intervention (PCI) using a guiding catheter with small diameters may have a favorable impact on vascular access complications and patient morbidity. Here, we report the initial results of PCI using a 4‐Fr coronary accessor. Methods: A total of 31 patients underwent 4‐Fr PCI. Exclusion criteria for 4‐Fr PCI were (1) lesions associated with large side branches requiring wire protection or kissing balloon technique and (2) planned use of angioplasty devices which were not compatible with 4‐Fr catheter. Results: A total of 36 lesions, including 4 chronic total occlusions (CTO), were treated. Access sites included radial artery in 19 patients (61%), brachial artery in 8 (26%), and femoral artery in 4 (13%). Four‐Fr PCI was successful in 34 of 36 lesions (94%) in 29 of 31 patients (94%). One of the two unsuccessful patients was a case of CTO, and the other a case of tortuous right coronary artery. In both, crossover to a 6‐Fr PCI was necessary. Among successfully treated 34 lesions of the 29 patients, coronary stents were deployed in 30 lesions (88%). There were no stent dislodgements or inadequate contrast opacification. No access‐site related complications including radial artery occlusion were observed. Conclusions: PCI with a 4‐Fr coronary accessor is a viable alternative to the use of larger guide catheters. The advent of 4‐Fr stent delivery system may afford a less invasive approach for the treatment of patients with coronary artery disease. © 2008 Wiley‐Liss, Inc.     

Reducing needle-to-balloon time by using a single guiding catheter during transradial primary coronary intervention

Objectives and Background: It is unknown whether using a single guiding catheter for both nonculprit and culprit vessel angiography and intervention during transradial primary percutaneous coronary intervention (PCI) is feasible. Methods: This single‐center study enrolled 242 consecutive patients with ST segment elevation myocardial infarction (STEMI) who received primary PCI. Among them, 102 patients received primary PCI via transfemoral approach (TFI), 109 patients received primary PCI via transradial approach using conventional technique (Conventional TRI), and 31 underwent primary TRI using a single guiding catheter (Single Guiding TRI). The catheter used for this purpose was 6 Fr RM® 3.5 guiding catheter. Results: Using a single guiding catheter, both coronary artery angiograms and intervention were successful in 30 of 31 patients (96.7%). Needle‐to‐balloon time (from puncture to first balloon) and door‐to‐balloon (D2B) time were similar between TFI and Conventional TRI groups and significantly lower in the Single Guiding TRI group (13.8 [TFI] and 14.1 [Conventional TRI] vs. 7.6 minutes, P < 0.001; 89.5 [TFI] and 91.0 [Conventional TRI] vs. 68.5 minutes, P = 0.008, respectively), whereas proportion of patients achieving D2B time within 90 minutes increased significantly in the Single Guiding TRI group from 51.0% for TFI and 49.5% for Conventional TRI to 74.2% (P = 0.023). Conclusions: Primary transradial PCI using a single guiding catheter is feasible and highly successful and might allow timely restoration of blood flow in infarct‐related artery. (J Interven Cardiol 2012;25:330–336)     

Transradial simultaneous kissing stenting (SKS) with SheathLess access

Transradial coronary intervention is usually performed via a 5 or 6 Fr sheath due to the small calibre of radial arteries. Simultaneous kissing stenting (SKS) technique requires a guiding catheter 7 Fr or larger and is therefore difficult to perform via transradial approach. Conversion to femoral approach or additional arterial access is usually required to achieve this goal. To overcome this limitation, a hydrophilic 7.5 Fr SheathLess guiding catheter can be exploited. This catheter possesses approximately the same size outer diameter as a 6 Fr sheath and an internal diameter of a 7.5 Fr catheter. A smooth and successful performance of SKS through transradial approach is described using this catheter. © 2009 Wiley‐Liss, Inc.     

A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions.

Transradial coronary interventions (TCI) are occasionally limited by radial spasms and postprocedural radial occlusions, which are related to the radial diameter and which possibly may be reduced by the use of smaller guiding catheter. However, 5 Fr, 0.058" lumen diameter guiding catheter affords less strength, visibility, and backup. In a randomized study, we investigated procedural and clinical success and vascular access complications of 5 Fr in comparison to 6 Fr guiding catheter. One hundred seventy-one patients with coronary lesions suitable for at least 5 Fr transradial approach (i.e., normal Allen test, only balloon angioplasty and stent) were randomly assigned for 5 or 6 Fr TCI. The primary combined endpoint was procedural and clinical success, and secondary endpoints were vascular access complications and the occurrence of postprocedural radial occlusions at 1-month follow-up. Procedural success was achieved in 95.4% of 5 Fr and 92.9% of 6 Fr patients. Selective cannulation of the coronary ostium failed in 1.1% of 5 Fr and 4.8% of 6 Fr patients (P = 0.08). Minor hematomas without need for surgical repair or blood transfusions occurred in 1.1% (5 Fr) and 4.8% (6 Fr; P = 0.07); 1.1% of 5 Fr and 5.9% of 6 Fr patients (P = 0.05) suffered loss of radial pulse due to radial occlusion. Selected noncomplex coronary lesions can successfully and safely be treated either with 5 or 6 Fr guiding catheters. A tendency of higher procedural success rates and lower vascular access complications was documented after 5 Fr in comparison to 6 Fr TCI. This was particularly the case among patients with small radial diameters.     

Surgical retrieval of dislodged stent during transradial coronary intervention

Coronary stent dislodgment is a rare but serious complication during percutaneous coronary intervention. During transradial coronary intervention, retrieval of a dislodged and deformed stent into the guiding catheter is difficult or impossible, since a small 6 Fr guiding catheter and sheath system is commonly used. I describe a new method to retrieve a dislodged and damaged stent during transradial coronary intervention. When a dislodged and unexpanded stent is not pulled back completely into the guiding catheter, the damaged stent and guiding catheter can be withdrawn together into the radial artery and retrieved successfully by radial artery cutdown and repair method.     

Radial Versus Femoral Access for Percutaneous Coronary Intervention: Implications for Vascular Complications and Bleeding

Since its advent over two decades ago, transradial access for cardiac catheterization and percutaneous intervention has evolved into a versatile and evidence-based approach for containing the risks of access-site bleeding and vascular complications without compromising the technical range or success associated with contemporary percutaneous coronary intervention (PCI). Early studies demonstrated reduced rates of vascular complications and access-site bleeding with radial-access catheterization but at the cost of increased access-site crossover and reduced procedural success. Contemporary data demonstrate that while the rates of major bleeding with femoral-access PCI in standard-risk cohorts have declined significantly over time, the transradial approach still retains significant advantages by way of reductions in vascular complications, length of stay, and enhanced patient comfort and patient preference over the femoral approach, while maintaining procedural success. Major adverse cardiovascular events and bleeding are lowest with the transradial approach when procedures are performed at high-volume radial centers, by experienced radial operators, or in the context of ST-segment elevation myocardial infarction. Choice of procedural anticoagulation appears to differentially impact access-site bleeding in transradial versus transfemoral PCI; however, non-access site bleeding remains a significant contributor to major bleeding in both groups. Despite abundant supporting data, adoption of transradial technique as the default strategy in cardiac catheterization in the United States has lagged behind many other countries. However, recent trends suggest that interest and adoption of the technique in the United States is growing at a brisker pace than previously observed.     

Balloon crush: treatment of bifurcation lesions using the crush stenting technique as adapted for transradial approach of percutaneous coronary intervention.

The recent advent of drug-eluting stents has allowed the crush stenting technique to be adopted, thus simplifying the treatment of bifurcation coronary artery lesions. However, this can only be achieved in 7 Fr or greater guiding catheters, hence precluding most transradial percutaneous coronary interventions that are usually undertaken using 6 Fr or less guiding catheters. We assessed the feasibility of balloon stent crush as a stepwise procedure in achieving bifurcation crush stenting in 6 Fr transradial percutaneous coronary interventions. Since it is not possible to place two stents through a 6 Fr guiding catheter, we have adapted the crush stenting technique by initially placing a stent in the side branch and a balloon in the main vessel. The side branch stent is then deployed against the main vessel balloon that is later inflated, crushing the side branch stent within the main vessel. The main vessel is then stented and the side branch recrossed for kissing inflations. Seven patients (five males; age range, 47-78 years) with bifurcation lesions were treated using the above-described technique without major complications. Balloon crush of the side branch stent were successfully achieved in all cases without balloon trapping. In six cases where side branch recrossing was attempted, all were successful and kissing balloon inflations were undertaken in five cases. We have demonstrated that the modified crush stenting technique is feasible and can be safely adapted for use in a 6 Fr transradial percutaneous coronary intervention approach.     

经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和介入治疗

目的探讨经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和介入治疗(PCI)的可行性和安全性。方法前瞻性单中心、随机对照研究,自2011年8月至12月,75例发病12h内的急性ST段抬高心肌梗死(STEMI)、拟行经桡动脉急诊PCI治疗的患者根据随机序号将患者按1:1比例随机分为MAC组和对照组:MAC组(37例)为直接应用MAC指引导管行冠状动脉造影和介入治疗,对照组(38例)为应用造影导管完成冠状动脉造影后再选择指引导管行介入治疗。比较两组患者血管穿刺成功率、导管室准备时间、鞘管置入时间、操作成功率、造影剂用量、操作时间、透视时间和导管室门-球囊(cathlab door to balloon,C2B)时间、穿刺部位并发症以及30天的主要心脏不良事件(死亡、非致死性心肌梗死和靶病变血运重建)发生率。结果 75例患者,其中男性57例,女性18例,年龄(61.5±12.2)岁。两组穿刺置管成功率均为100%,对照组1例患者因右桡尺动脉环而改股动脉路径完成手术。MAC组和对照组相比,两组患者的穿刺置管时间、PCI操作成功率和造影剂用量无明显差异[(1.73±1.08)min比(1.65±0.84)min,t=-0.398,P>0.05;89.2%比89.2%,χ2=0.140,P>0.05;(127±74)ml比(136±33)ml,t=1.159,P>0.05]。操作时间、C2B时间和透视时间MAC组均明显低于对照组[(27.27±6.97)min比(36.33±13.71)min,t=3.582,P<0.001;(15.11±4.77)min比(18.31±3.84)min,t=3.180,P=0.002;(7.61±3.04)min比(11.17±5.99)min,t=3.227,P=0.001]。穿刺部位并发症:局部血肿每组各2例。30天的主要心脏不良事件发生率两组相似(2.7%比2.7%)。结论经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和PCI是安全和可行的,能明显减少操作时间、透视时间和C2B时间。     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

Miniaturization of the equipment for percutaneous coronary interventions: a prospective study in 1,200 patients

The aim of this prospective study was to analyze the technical feasibility, success rate and special complications of percutaneous coronary interventions (PCI) using a newly released 5 French (Fr) guiding catheter with an inner diameter of 0.058 . The study was performed in 1,200 consecutive patients subjected to coronary angioplasty. In 92% of the patients, the intervention was started with a 5 Fr catheter; in 8% of the patients, a 6 or 7 Fr catheter was used. In 5% of the 1,105 patients, the guiding catheter had to be changed during PCI from 5 Fr to a 6 or 7 Fr catheter. In 92% of the patients, the intervention was successfully performed using a 5 Fr catheter. In 3%, the overall success rate was 95% after changing the guiding catheter. Predictors of procedural failure with the 5 Fr guiding catheter were type C lesion morphology and a diameter stenosis of 99% and 100%. The success rate was 90% in acute functional occlusions and 63% in chronic total occlusions (CTO). In CTOs, predictors of procedural failure of the recanalizations using 5 Fr guiding catheters were sidebranch at the point of the total occlusion, complex lesion morphology type C and abrupt morphology of the occlusion. This study confirms that PCI was technically feasible using a 5 Fr guiding catheter in the majority of consecutive patients (success rate: 92%). There were significant differences in the success rate depending on the lesion type and the diameter stenosis.     

The GuideLiner "child" catheter for percutaneous coronary intervention - early clinical experience

The failure to deliver a stent across the target lesion during percutaneous coronary intervention, especially in arteries with calcified tortuous anatomy, is often due to insufficient back-up support from the guiding catheter. Deep-vessel intubation with the guiding catheter may overcome this problem, but risks coronary dissection. The Heartrail II (Terumo, Japan) "five-in-six catheter system" (or "mother-and-child" catheter) comprises a flexible-tipped long 5 Fr catheter advanced through a standard 6 Fr guiding catheter to deeply intubate the target vessel, thus providing enough back-up support to enable stent delivery. Here we describe a newly developed "child" support catheter (The GuideLiner; Vascular Solutions, Inc., Minneapolis, Minnesota), report its successful use in a series of 4 difficult cases and discuss practical tips to optimize its performance.     

Percutaneous coronary interventions using a new 5 French guiding catheter: results of a prospective study.

The aim of this prospective study was to analyze the technical feasibility, the success rate, and the special complications of percutaneous coronary interventions (PCIs) using a newly released 5 Fr guiding catheter with an inner diameter of 0.058". The study was performed in 150 consecutive patients subjected to coronary angioplasty. In 89% of the patients, the intervention was started with a 5 Fr catheter (JR4 or JL4); in 16 patients a 6 or 7 Fr catheter was used because of unstable clinical conditions according to the decision of the interventional cardiologist. In 12 out of 134 patients, the guiding catheter had to be changed during the intervention from 5 Fr to a 6 or 7 Fr catheter due to poor backup support. In 112 out of 118 patients, the intervention was successfully performed using a 5 Fr catheter (95%); in 12 out of 16 patients, after changing the guiding catheter, the overall success rate was 93%. In patients with type A and B lesions who were initially treated using a 5 Fr catheter, the procedural success rate was 100% (81 out of 81), whereas in patients with type C lesions the procedural success rate was 83% (43 out of 53; P = 0.000053, Fisher's exact test). Furthermore, in patients with a diameter stenosis < 90%, the procedural success rate was 100% (57 out of 57), whereas in patients with a diameter stenosis of 90%-100%, the procedural success rate was 87% (67 out of 77; P = 0.0050). Stent implantation was performed successfully in 24 patients (18%) using the 5 Fr guiding catheter. This study confirms that PCI was technically feasible using a 5 Fr guiding catheter in the majority of consecutive patients with a success rate of 95%. There were significant differences in the success rate depending on the lesion type and the diameter stenosis. Complications were very rare and were not related to the guiding catheter. Limitations of the 5 Fr guiding catheters arose mainly from a poor backup support in long lesions and severe stenosis. Cathet Cardiovasc Intervent 2001;53:308-312. Copyright Wiley-Liss, Inc.     

Perforation of the sinus of Valsalva by guiding catheter during the percutaneous coronary intervention via the right transradial approach: A very unusual complication

Iatrogenic dissection of the sinus of Valsalva or of the ascending aorta is a rare but potentially fatal event, during the percuteneous coronary intervention (PCI). We reported a case of perforation of the sinus of Valsalva by guiding catheter during PCI via the right transradial approach (TRA) successfully managed and sealed without any sequelae. The choice of guiding catheter into the right TRA should be done carefully and its manipulation should be performed with caution in the coronary artery and in the sinus of Valsalva. © 2011 Wiley Periodicals, Inc.     

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。     

Entrapment of a kinked catheter in the radial artery during transradial coronary angiography

The transradial approach is currently popular for vascular access during percutaneous coronary angiography and intervention. Catheter kinking during catheter manipulation is not uncommon, but mostly the kinked catheter can be unraveled by gentle rotation of catheter in the opposite direction. We describe a case in which the diagnostic catheter was kinked and entrapped in the small radial artery during transradial angiography. Attempts to withdraw or to unravel the catheter with gentle rotation were unsuccessful. We were able to catch the catheter tip with a 6 Fr Amplatz goose-neck snare kit (ev3, Inc.) guided by an 8 Fr guiding catheter via right femoral approach. We pulled the kinked catheter up into the brachial artery with large diameter where successful unraveling was possible, allowing for its successful removal through the radial sheath.     

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.