主动脉外置导丝处理冠状动脉开口病变的效果观察

目的 在经皮冠状动脉介入(PCI)术中采用主动脉外置导丝的新方法处理冠状动脉开口病变,并与常规PCI方法对比,观察其临床效果.方法 冠状动脉开口病变患者86例,随机分为常规方法处理组和主动脉外置导丝组.常规处理组采用标准PCI术式,外置导丝组在导引导管进入冠状动脉开口前,将1根导丝送至主动脉外置,其余操作同标准PCI术.统计两组所用导引导管数最、导丝数量、X线曝光时间、PCI总时间、对比剂剂最、压力嵌顿次数、恶性心律失常次数和手术失败例数,进行对比分析.结果 常规处理组导引导管数为(2.3±1.1)根,外置导丝组为(1.3±0.5)根,两组比较差异有统计学意义(P＜0.01);两组使用导丝数量差异无统计学意义[常规处理组(2.0±1.1)根,外置导丝组(2.2 ±0.4)根,P＞0.05].与常规处理组比较,外置导丝组显著减少X线曝光时间[常规处理组(18.8 ±6.9)min,外置导丝组(14.2 ±5.7)min,P＜0.01],缩短PCI总时间[常规处理组(31.2±8.1)min,外置导丝组(20.1±4.5)min,P＜0.01],减少对比剂用量[常规处理组(193.5±25.4)ml,外置导丝组(130.6±32.8)ml,P＜0.01],术中出现嵌顿的次数明显减少(常规处理组19例次,外置导丝组2例次,P＜0.01).常规处理组术中出现恶性心律失常8例次,PCI失败6例,外置导丝组无恶性心律失常及失败病例.结论 主动脉外置导丝处理冠状动脉开口病变,方法简单,容易掌握,可有效避免PCI术中导管嵌顿,减少风险,提高手术成功率.

Benefits of placing intra-aortic vacant guide wire on interventional treatment of aorto-ostial lesions

Objective To evaluate the potential benefits of placing intra-aortic vacant guide wire on interventional treatment of aorto-ostial lesions. Methods A total of 86 consecutive patients underwent percutaneous coronary interventions (PCI) for aorto-ostial lesions were randomly divided into conventional treatment group ( group A) and intra-aortic vacant guide wire group ( group B). Standard PCI techniques were applied in group A and an intro-aortic vacant guide wire was placed outside the guiding catheter before the guiding catheter into the target coronary artery in group B on basis of standard PCI techniques. The number of guiding catheter, guide wire, X-ray exposure time, total PCI time, the incidence of pressure drop and malignant arrhythmia, contrast agent dose and the number of failure cases were compared between the two groups. Results The number of used guide wire was similar between the groups (2. 0 ± 1. 1 vs. 2. 2 ±0.4, P＞0. 05) and the number of guiding catheter used was significantly more in group A than in group B (2. 3 ± 1. 1 vs. 1.3±0. 5, P ＜0. 01 ). The X-ray exposure time ( 18. 8 min ±6. 9 min vs. 14. 2 min ±5.7min, P＜ 0.01) was significantly less in groups B and the total PCI time (31.2 min ±8. 1 min vs. 20. 1min ± 4. 5 min, P ＜ 0. 0 1 ) and the amount of contrast agent ( 193.5 ml ± 25.4 ml vs. 130. 6 ml ± 32. 8 ml,P ＜0. 01 ) and the frequency of pressure drop ( 19 cases vs. 2 cases, P ＜0. 01 ) were all significantly higher in group A than in group B. Incidence of malignant ventricular arrhythmia (8 vs. 0) and procedure failure (6 vs. 0) was also higher in group A compared to group B. Conclusion The method of using Intra-aortic vacant guide wire is associated with reduced risk and improved success rate of PCI for aorto-ostial lesions.