PTCA导丝在冠状动脉造影桡动脉痉挛时的应用价值

目的探讨经皮冠状动脉(冠脉)腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝在冠脉造影桡动脉痉挛时的应用价值。方法将行经桡动脉冠脉造影和(或)介入治疗术发生桡动脉痉挛的106例分为PTCA导丝组36例和药物组70例。PTCA导丝组在造影路径指导下更换泥鳅导丝为PTCA导丝完成造影;药物组沿鞘管侧管注入维拉帕米1 mg和硝酸甘油200μg,等待5 min后再次行桡动脉造影,观察两组经桡动脉冠脉造影成功率及并发症。结果药物组重度痉挛占88.6%,弥漫痉挛占38.6%;PTCA导丝组重度痉挛占97.2%,弥漫痉挛占41.7%,两组痉挛严重及弥漫程度比较差异无统计学意义(P>0.05)。PTCA导丝组PTCA导丝均通过病变部位,在PTCA导丝指引下5 F造影导管通过病变部位冠脉造影成功率94.4%。药物组再次造影桡动脉痉挛改善,经桡动脉冠脉造影成功率84.3%,两组比较差异无统计学意义(P>0.05)。药物组、PTCA导丝组手术时间分别为(45.6±18.1)min、(29.1±13.7)min,两组比较差异有统计学意义(t=4.80,P=0.001)。PTCA导丝组出现血管并发症2例(5.6%);药物组出现血管并发症18例(25.7%),两组比较差异有统计学意义(χ2=7.41,P=0.01)。结论冠脉造影桡动脉痉挛时可尝试使用PTCA导丝完成造影,该方法安全可行。

Significance of PTCA Guidewire in the Radial Artery Spasm during Coronary Artery Angiography

Objective To observe the significance of percutaneous transluminal coronary angioplasty(PTCA) guidewire in the radial artery spasm during transradial coronary artery angiography.Methods 106 patients with radial artery spasm during transradial coronary angiography or interventional therapy via trans-radial artery approach were selected and divided into 2 groups.PTCT guidewire group(36 cases) used PTCA guidewire instead of loach guidewire to run through the spasmend radial artery.Medicinal group(70 cases) were given 200 μg of Nitroglycerin and 1 mg of Verapamil.5 min later,they underwent coronary artery angiography.The achievement ratio and complication of angiography were observed in two groups.Results In the medicinal group,severe spasm was 88.6%%,diffuse spasm was 38.6%;In the PTCT guidewire group,severe spasm was 97.2%,diffuse spasm was 41.7%.The severity degree and diffuse degree of spasm in the 2 groups showed no significant difference(P>0.05).In PTCT guidewire group PTCA guidewire through the diseased region,the coronary artery angiography achievement ratio of 5 F Catheters through the diseased region under the PTCT guidewire were 94.4%;in medicinal group radial artery spasm improvement rate after coronary artery angiography,the coronary arteriongraphy achievement ratio of radial artery approach were 84.3%.There was no significant difference between the two groups(P>0.05).The operation time in medicinal group was(45.6±18.1)min,and(29.1±13.7) min in the PTCA guidewire group,and there was significant difference between the two groups(t=4.80,P=0.001).In the PTCT guidewire group,blood vessels complication rate was 5.6%(2 cases);in the medicinal group,blood vessels complication rate was 25.7%(18 cases).There was significant difference between the two groups(χ2 =7.41,P=0.01).Conclusion In case of radial artery spasm during coronary artery angiography,PTCT guidewire can be used as a safe and feasible approach.