经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估

doi:10.3969/j.issn.1006-7795.2019.03.012

首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (3): 383-388.doi: 10.3969/j.issn.1006-7795.2019.03.012

经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估

牛丹¹, 华琦², 柳子静¹, 闫蕊¹, 张利彬¹, 孙雨华¹, 王国忠¹, 张海滨¹, 郭金成¹

1. 首都医科大学附属北京潞河医院心内科, 北京 101149;
2. 首都医科大学宣武医院心内科, 北京 100054

收稿日期:2019-03-15 出版日期:2019-05-21 发布日期:2019-06-13
通讯作者: 郭金成 E-mail:guojcmd@126.com
基金资助:
北京市通州区科技计划项目（KJ2018CX009）。

Evaluation of acute and chronic radial artery injury after transradial coronary intervention

Niu Dan¹, Hua Qi², Liu Zijing¹, Yan Rui¹, Zhang Libin¹, Sun Yuhua¹, Wang Guozhong¹, Zhang Haibin¹, Guo Jincheng¹

1. Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China;
2. Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Received:2019-03-15 Online:2019-05-21 Published:2019-06-13
Supported by:
This study was supported by Science and Technology Planning Project of Tongzhou District,Beijing (KJ2018CX009).

摘要/Abstract

摘要： 目的应用光学相干断层成像（optical coherence tomography，OCT）评价经桡动脉冠状动脉介入术（transradial intervention，TRI）后桡动脉急慢性损伤。方法回顾性分析2017年5月至2018年4月行TRI及桡动脉OCT检查的患者114例。根据患者既往是否经同侧桡动脉行介入治疗分为首次TRI组（n=87）和重复TRI组（n=27）。TRI结束后将鞘管回撤至距穿刺点2 cm处并对桡动脉近段、中段和远段行OCT检查，比较两组患者桡动脉急性损伤（内膜撕裂、夹层、穿孔、血栓和痉挛）发生率及慢性损伤（内膜增生）。结果 114例患者桡动脉内膜撕裂、夹层、穿孔、血栓及痉挛的发生率分别为31.6%、14.0%、1.8%、26.3%和50.0%。首次TRI组与重复TRI组患者急性损伤发生率差异无统计学意义（撕裂：28.7%vs 40.7%，P=0.680；夹层：13.8%vs 14.8%，P=0.782；穿孔：2.8%vs 0.0%，P=0.965；血栓：26.4%vs 25.9%，P=0.958；痉挛：51.7%vs 44.4%，P=0.509）。两组患者桡动脉各段急性损伤发生率差异均无统计学意义（P值均>0.05）。重复TRI组管腔狭窄率、内膜与中膜厚度比值和内膜厚度指数均明显高于首次TRI组（P值均<0.05）。结论重复TRI组与首次TRI组桡动脉急性损伤发生率差异无统计学意义；重复TRI组患者桡动脉内膜增生明显。

关键词: 桡动脉, 冠状动脉介入, 光学相干断层成像

Abstract: Objective To evaluate acute and chronic effects of transradial intervention (TRI) on the radial artery (RA) with optical coherence tomography (OCT). Methods A total of 114 patients who underwent RA OCT examination after TRI during May 2017 to April 2018 were retrospectively enrolled in this study. The patients were divided into the first TRI group (n=87) and the repeat TRI group (n=27) based on whether the patients had experienced a homolateral TRI before. Immediately after TRI, the sheath was extracted 2 cm distal to the puncture site. The RA was examined with OCT and then divided into three parts:proximal, medial and distal. The acute injuries including intimal tear, dissection, perforation, thrombus and spasm as well as chronic injury like intimal hyperplasia of all segments of radial artery between the two groups were analyzed and compared.Results The incidence rate of intimal tear, dissection, perforation, thrombus and spasm was 31.6%, 14.0%, 1.8%, 26.3% and 50.0%, respectively. There was no significant difference in the incidence of acute injury between the first TRI group and the repeat TRI group (tear:28.7% vs 40.7%, P=0.680; dissection:13.8% vs 14.8%, P=0.782; perforation:2.8% vs 0.0%, P=0.965; thrombus:26.4% vs 25.9%, P=0.958; spasm:51.7% vs 44.4%, P=0.509). As compared with the first TRI group, the intimal hyperplasia indexes like percentage of luminal narrowing (LN%), intima-media ratio (IMR) and intimal thickness index (ITI) were significantly higher in the repeat TRI group (P<0.05). Conclusion There was no significant difference between the repeat TRI group and the first TRI group in the incidence of acute injury. The intimal hyperplasia of RA was significant in repeat TRI group.

Key words: radial artery, coronary intervention, optical coherence tomography

中图分类号:

R540.4

牛丹, 华琦, 柳子静, 闫蕊, 张利彬, 孙雨华, 王国忠, 张海滨, 郭金成. 经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估[J]. 首都医科大学学报, 2019, 40(3): 383-388.

Niu Dan, Hua Qi, Liu Zijing, Yan Rui, Zhang Libin, Sun Yuhua, Wang Guozhong, Zhang Haibin, Guo Jincheng. Evaluation of acute and chronic radial artery injury after transradial coronary intervention[J]. Journal of Capital Medical University, 2019, 40(3): 383-388.

参考文献

[1] Vranckx P, Frigoli E, Rothenbühler M, et al. Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation[J]. Eur Heart J, 2017,38(14):1069-1080.
[2] Valgimigli M, Frigoli E, Leonardi S, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX):final 1-year results of a multicentre, randomised controlled trial[J]. Lancet, 2018,392(10150):835-848.
[3] 郭金成, 王国忠, 朱芙丽, 等. 经桡动脉应用MAC指引导管行急诊冠状动脉造影和介入治疗的可行性[J]. 首都医科大学学报, 2015,36(1):78-83.
[4] Neumann F J, Sousa-Uva M, Ahlsson A,et al. 2018 ESC/EACTS guidelines onmyocardial revascularization[J]. Eur Heart J, 2019,40(2):87-165.
[5] Prati F, Kodama T, Romagnoli E, et al. Suboptimal stent deployment is associated with subacute stent thrombosis:Optical coherence tomography insights from a multicenter matched study. From the CLI Foundation investigators:the CLI-THRO study[J]. Am Heart J, 2015,169(2):249-256.
[6] Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery[J]. N Engl Med, 2018,378(22):2069-2077.
[7] Yonetsu T, Kakuta T, Lee T, et al. Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography[J]. Eur Heart J, 2010,31(13):1608-1615.
[8] Di Vito L, Burzotta F, Trani C, et al. Radial artery complications occurring after transradial coronary procedures using long hydrophilic-coated introducer sheath:a frequency domain-optical coherence tomography study[J]. Int J Cardiovasc Imaging, 2014,30(1):21-29.
[9] 毕希乐, 樊延明, 汪雁博, 等. 光学相干断层成像观察经桡动脉冠状动脉介入术后硝酸甘油对桡动脉结构的影响[J]. 中国循环杂志, 2018,33(1):36-40.
[10] Novakova T, Kanovsky J, Miklik R, et al. Short sheath benefit in radial artery injury after PCI-optical coherence tomography serial study[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2016, 160(3):393-398.
[11] Kala P, Kanovsky J, Novakova T, et al. Radial artery neointimal hyperplasia after transradial PCI-Serial optical coherence tomography volumetric study[J]. PLoS One, 2017,12(10):e0185404.
[12] Ruzieh M, Moza A, Siddegowda Bangalore B, et al. Effect of transradial catheterisation on patency rates of radial arteries used as a conduit for coronary bypass[J]. Heart Lung Circ, 2017,26(3):296-300.
[13] Kwok C S, Rashid M, Fraser D, et al. Intra-arterial vasodilators to prevent radial artery spasm:a systematic review and pooled analysis of clinical studies[J]. Cardiovasc Revasc Med, 2015,16(8):484-490.
[14] Kobayashi H, Kitamura S, Kawachi K, et al. A pathohistological and biochemical study of arteriosclerosis in the internal thoracic artery, a vessel commonly used as a graft in coronary artery bypass surgery[J]. Surg Today, 1993,23(8):697-703.
[15] Kaufer E, Factor S M, Frame R, et al. Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts[J]. Ann Thorac Surg, 1997,63(4):1118-1122.
[16] Chowdhury U K, Airan B, Mishra P K, et al. Histopathology and morphometry of radial artery conduits:basic study and clinical application[J]. Ann Thorac Surg, 2004, 78(5):1614-1621.

经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估

Evaluation of acute and chronic radial artery injury after transradial coronary intervention

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	孙昊, 郑美丽, 郭宗生, 张智勇, 李晓涛. 左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响[J]. 首都医科大学学报, 2022, 43(2): 305-310.
[2]	牛丹, 华琦, 柳子静, 李紫旋, 宋佳慧, 闫蕊, 王国忠, 张利彬, 郭金成. 首次和重复经桡动脉冠状动脉介入术后桡动脉无鞘区急慢性损伤的光学相干断层成像比较[J]. 首都医科大学学报, 2020, 41(3): 464-469.
[3]	郝鹏, 冯斯婷, 甄雷, 王晓, 王春梅, 聂绍平. SYNTAX II评分对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值[J]. 首都医科大学学报, 2019, 40(5): 744-748.
[4]	吴晴晴, 华琦, 薛淞, 张迎花, 司瑾, 李静. 白细胞计数与急性ST段抬高型心肌梗死病人直接经皮冠状动脉介入术中无复流的关系[J]. 首都医科大学学报, 2017, 38(3): 372-376.
[5]	王国忠, 华琦, 柳子静, 郝明辉, 徐荣, 张利彬, 陈文明, 郭金成. 基层医院通过微信院前激活导管室对急性ST段抬高型心肌梗死病人再灌注时间的影响[J]. 首都医科大学学报, 2017, 38(3): 391-396.
[6]	高德全, 贾文芳, 谢亚闯, 刘明涛, 董新博, 方雪花, 李晓涛. 碎裂QRS波群在经皮冠状动脉介入治疗急性前壁心肌梗死病人中的预测价值[J]. 首都医科大学学报, 2017, 38(3): 470-474.
[7]	王艳玲, 华琦, 刘志, 褚研研. 晚期时相肢体缺血预适应对冠状动脉介入术患者的预后影响[J]. 首都医科大学学报, 2015, 36(3): 393-398.
[8]	李博宇, 华琦, 李静, 邵强, 褚研研. 急性冠状动脉综合征患者介入术后1年肾功能变化及影响因素的分析[J]. 首都医科大学学报, 2015, 36(1): 58-62.
[9]	许骥, 华琦, 胡少东, 刘志, 李博宇, 桑成, 夏经钢. 替格瑞洛在老年STEMI患者急诊PCI中的疗效与安全性分析[J]. 首都医科大学学报, 2015, 36(1): 73-77.
[10]	郭金成, 王国忠, 朱芙丽, 陈文明, 柳子静, 徐荣, 张利彬. 经桡动脉应用MAC指引导管行急诊冠状动脉造影和介入治疗的可行性[J]. 首都医科大学学报, 2015, 36(1): 78-83.
[11]	关欣亮;艾辉;王春梅;李艳芳;朱小玲. 对应导联ST段压低在急性ST段抬高心肌梗死患者中的临床价值[J]. 首都医科大学学报, 2012, 33(6): 818-821.
[12]	王长华;陈韵岱;杨新春;王乐丰;王红石;孙志军;刘宏斌;陈练. 女性患者急诊冠状动脉介入后无复流的独立预测因素[J]. 首都医科大学学报, 2012, 33(4): 432-436.
[13]	许晓晗;张维君;周玉杰;周志明;马涵英;胡宾;康云鹏;雒芳芳. 曲美他嗪对PCI术相关心肌损伤及术后再发心绞痛症状的临床研究[J]. 首都医科大学学报, 2012, 33(4): 457-461.
[14]	刘武;刘芳;莫宾;李倩;汪东生;卢清君. 视网膜一步穿刺法植入视网膜下聚酰亚胺载片的实验研究[J]. 首都医科大学学报, 2010, 31(1): 36-38.
[15]	张东亮;廖华;张莉;刘文虎. 非对称性二甲基精氨酸对人阻力血管EDVD的抑制作用[J]. 首都医科大学学报, 2009, 30(2): 121-125.