经皮冠状动脉介入治疗术中桡动脉穿孔的危险因素与处置策略

目的探讨经皮冠状动脉介入治疗(PCI)术中桡动脉穿孔的危险因素及处置策略。方法回顾分析经桡动脉PCI术中桡动脉穿孔的16例患者,记录术中桡动脉造影情况、桡动脉穿孔原因、导致穿孔的器械、处理方法和术后恢复情况等,通过定义桡动脉穿孔分型指导处置策略。结果 16例患者中桡动脉穿孔的原因包括,桡动脉解剖学变异为12例,桡动脉痉挛2例,超滑导丝穿出2例。其中7例Ⅰ型桡动脉穿孔均未行特殊处理,其余9例患者均接受加压包扎,前臂血肿张力较大的患者进行穿刺减压。术后随访4例患者出现桡动脉闭塞。结论桡动脉穿孔是经桡动脉PCI的少见并发症,可能会导致严重后果,及时行桡动脉造影,早期识别桡动脉穿孔并及时给予治疗,是有效预防前臂严重血肿、骨筋膜室综合征甚至于急性手缺血的关键。

Risk factors and management strategies of iatrogenic radial artery perforation during percutaneous coronary intervention

Objective To analyze the risk factors and management strategies of iatrogenic radial artery perforation during percutaneous coronary intervention. Methods A total of 16 patients undergoing percutaneous coronary intervention who were complicated by iatrogenic radial artery perforation were followed. Radial artery angiographic findings,procedural records and clinical outcomes were reviewed. A new radial artery perforation classification was proposed to be used for appropriate and early triage these patients. Results Of 16 patients, radial artery perforation was associated with anatomic variations in 12 cases, radial artery spasm in 2 cases, and forceful manipulation of hydrophilic guidewire in 2 cases. Seven patients with a small radial artery perforation managed conservatively without the development of forearm hematoma, the others were successfully treated by external compression on the perforated segment or puncture decompression as well. Four patients of subsequent radial artery occlusion were observed during short-term follow-up. Conclusion Radial artery perforation is a rare complication of transradial percutaneous coronary intervention with potentially fatal consequences. Early recognition of the perforation by radial artery angiography and immediate treatment are absolutely of great importance to prevent major hematoma, compartment syndrome and subsequent acute hand ischemia.