经左侧桡动脉行冠状动脉介入术的临床优势探讨

目的与经右侧桡动脉途径相比较探讨经左侧桡动脉进行冠脉介入术的优势。方法 956例患者分别经左侧桡动脉途径（A组,558例）和右侧桡动脉途径（B组,398例）进行冠脉造影及经皮冠状动脉介入术（PCI）,观察分析两组的成功率、失败原因以及导管应用类型和到位时间。结果在造影成功率上经左侧和右侧桡动脉途径差异无统计学意义（91.2%比89.4%,χ2=5.375,P=0.251）;在PCI成功率上两组统计学差异无统计学意义（42.8%比49.2%,χ2=3.384,P=0.066）。在造影失败的原因中,在锁骨下动脉迂曲及头臂干迂曲钙化/闭塞不能通过的发生率在右侧桡动脉途径更高（45.2%）,并且为经右侧桡动脉造影失败的最主要原因;在PCI中,指引导管一次到位成功（92.2%比74.9%,χ2=22.272,P=0.0002）或更换指引导管后成功（6.0%比18.3%,χ2=14.537,P=0.0001）以及桡动脉途径失败需要改为股动脉途径在B组中发生率更高（1.8%比6.9%,χ2=6.629,P=0.012）。在两组中JudkinsL3.5（79.2%比81.7%,χ2=0.87,P=0.351）和R3.5（78.2%比80.3%,χ2=0.582,P=0.445）的应用率最高。在穿刺-鞘管到位时间上两组比较差异无统计学意义（92.29±20.73）s比（96.16±21.13）s,t=1.04,P=0.253,但在导管到位时间上A组较B组差异有统计学意义。结论经左侧桡动脉途径进行冠脉介入术和右侧相比有一定的优势。克服操作距离大、穿刺困难的因素,左侧桡动脉值得推广。

The beneficial effect of percutaneous coronary intervention via left transradial

Objective To study the superiority of left transradial approach over the right transradial approach in coronary angiography and angioplasty.Methods A total of 956 patients undergoing coronary angiography and angioplasty were randomized to be performed through left（group A,n=558）or right（group B,n=398）transradial approach.The success rates,causes of procedure failure,the catheter model applied and the catheter placing time were compared between the 2 groups.Results There was no difference in the two groups in the success rates of angiography（91.2% vs 89.4%,P=0.251）and coronary intervention（42.8% vs 49.2%,P=0.066）.Failing rates caused by curved subclavian artery or branchiocephalic trunk which hindering catheter passing and placing in group B were higher than that of group A（45.2% vs 24.5%,P=0.037）.PCI succeed by primary placing guiding catheter（92.2% vs 74.9%,P=0.0002）or by changing guiding catheter（6.0% vs 18.3%,P=0.0001）were of different success rates between the 2 groups.The rates of shifting to femoral route in group B were higher than in group A（1.8% vs 6.9%,P=0.012）.The use of cather Judkins L 3.5（79.2% vs 81.7%,P=0.351）and R 3.5（78.2% vs 80.3%,P=0.445）were similar in the two groups.There was no difference on the puncture-sheild time between the two groups（92.29±20.73 s vs 96.16±21.13 s,P=0.253）,but there was a statistic difference between two groups in terms of catheter placing time with shorter time needed in the left transradial approach.Conclusion It is convenient and safe to carry out coronary intervention by left transradial approach compared with right transradial.