经桡动脉穿刺冠状动脉造影后即刻经桡动脉介入治疗

目的探讨冠心病心绞痛患者经桡动脉穿刺冠状动脉造影术后即刻选择经桡动脉行冠状动脉介入治疗的可行性、并发症以及近期疗效。方法选择临床诊断为冠心病心绞痛经桡动脉造影显示明确的冠状动脉病变后即刻采取经桡动脉介入治疗(PCI)的患者117例(桡动脉组),与同期经股动脉途径造影后即刻PCI者(股动脉组,共409例)进行比较,分析两组靶血管病变特征、疗效和并发症,并随访术后1月内心绞痛复发、心肌梗死、死亡等主要心血管事件的发生率。结果桡动脉组PCI成功率为94.0%,与股动脉组(97.6%)相比无明显差异(P>0.05)。桡动脉组造影显示明显病变(管腔狭窄程度≥70%)的血管数量累计为210支,其中182支作为靶血管进行了成功的PCI,病变血管的血运重建率为86.7%,低于股动脉组(93.4%),差异具有显著性(P<0.01)。而且成功PCI者中慢性闭塞病变的所占的比例也明显低于股动脉组,差异具有显著性(P<0.05)。桡动脉组术后与穿刺有关的总的并发症的发生率明显低于股动脉组(P<0.01)。术后平均卧床时间和平均住院天数均明显短于股动脉组。随访PCI术后1个月期间主要心血管事件两组之间无明显差异(P>0.05)。结论经桡动脉穿刺冠状动脉造影术后即刻行冠状动脉介入治疗的成功率较高,并发症少,具有可行性。但对于复杂病变选择经股动脉途径PCI

Direct percutanous coronary intervention immediately after transradial artery approach of coronary angiography

Objective To assess the feasibility,safety and clinical outcome of direct percutanous coronary intervention(PCI) immediately after transradial artery approach of coronary angiography in angina patients. Methods Direct PCI immediately after transradial artery approach of coronary angiography were done in 117 angina patients (radial group). The characteristics of the target lesion, clinical outcomes and complications related to PCI were analyzed and compared with the group of 409 patients who received direct PCI after angiogram from the femoral approach (femoral group). The recurrent of angina, myocardial infarction and coronary death during 1 month follow-up were recorded in each group. Results The total success rate of PCI was 94.0% in transradial group compared with 97.6% in transfemoral group (P>0.05). The rate of total complications related to puncture after procedure in radial group was less than femoral group (12.0% vs 34.2%, P<0.01). But in radial group,182 out of 210 of the obvious stenosis vessels as the target vessel received successful PCI. The revascularization rate of the diseased vessel was 86.7%, which was lower than that of femoral group (93.4%,P<0.01), and the ratio of relatively complex lesions in the total target lesions in radial group was also lower than femoral group (P<0.05).Conclusions Transradial PCI immediately after transradial artery approach of coronary angiography has a high success rate and less punctural related complications,but transfemoral approach of PCI is still the better choice in patient with relatively complex coronary disease.