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目的分析经桡动脉对冠状动脉慢性闭塞性(CTO)病变进行介入治疗的可行性、临床效果和手术成功的影响因素。方法回顾2003年1月至2006年6月首都医科大学附属北京安贞医院心内科156例患者187处CTO病变经桡动脉行介入治疗的资料。分析开通组(135处病变)和未开通组(52处病变)的临床、介入影像特征、器械应用、主要并发症等情况。结果187处CTO病变中135处病变经桡动脉成功开通,52处病变未能开通,成功率72%;两组临床特征、病变血管位置、直径差异无统计学意义。开通组与未开通组病变形态、长度、时间差异均有统计学意义(P<0.05):锥形病变71%对52%,平齐病变29%对48%。钙化病变14%对40%,桥侧支12%对35%,闭塞时间(5.2±4.3)个月对(9.2±5.4)个月。病变长度≤15 mm 87%对15%,病变长度>15 mm13%对85%。失败原因主要是导引钢丝或球囊未能通过病变部位。多元分析显示CTO持续时间是影响开通率最重要的因素。术后发生前臂血肿1例,桡动脉闭塞1例,未见其他严重并发症。结论经桡动脉介入治疗CTO病变安全可行,成功率较高,无严重并发症。
Objective To analyze the feasibility, clinical effect and influencing factors of successful operation of transradial artery in the treatment of chronic coronary artery occlusive disease (CTO). Methods From January 2003 to June 2006, data of 187 patients with CTO lesions undergoing percutaneous coronary intervention in 156 patients with cardiology at Beijing Anzhen Hospital, Capital Medical University from January 2003 to June 2006 were retrospectively reviewed. The clinical characteristics, instrumental features, major complications and so on in open group (135 lesions) and unopened group (52 lesions) were analyzed. Results Of the 187 CTO lesions, 135 lesions were successfully opened through the radial artery and 52 lesions failed to open. The success rate was 72%. There was no significant difference in the clinical features, lesion vessel position and diameter between the two groups. There were significant differences in the morphology, length and time of lesions between open group and non-opened group (P <0.05): 71% versus 52% for conical lesions and 29% to 48% for flush lesions. Calcification lesion 14% vs 40%, lateral branch of the bridge 12% vs 35%, occlusion time (5.2 ± 4.3) months vs (9.2 ± 5.4) months. Length of lesion ≤ 15 mm 87% vs 15%, lesion length> 15 mm 13% vs 85%. The main reason for the failure is to guide the wire or balloon failed to pass the lesion. Multivariate analysis showed that the duration of CTO was the most important factor affecting the rate of opening. One case had forearm hematoma and one case had radial artery occlusion. No other serious complications occurred. Conclusion Transradial interventional CTO lesions safe and feasible, a high success rate, no serious complications.