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

doi:10.3969/j.issn.1006-7795.2020.03.026

首都医科大学学报 ›› 2020, Vol. 41 ›› Issue (3): 464-469.doi: 10.3969/j.issn.1006-7795.2020.03.026

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

牛丹¹, 华琦², 柳子静², 李紫旋¹, 宋佳慧¹, 闫蕊¹, 王国忠¹, 张利彬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:2019-12-22 出版日期:2020-06-21 发布日期:2020-06-17
通讯作者: 郭金成 E-mail:guojcmd@126.com
基金资助:
首都卫生发展科研专项项目（2018-2-7082）。

Comparison of acute and chronic non-sheathed radial artery injury between the first and repeat transradial intervention by optical coherence tomography

Niu Dan¹, Hua Qi², Liu Zijing², Li Zixuan¹, Song Jiahui¹, Yan Rui¹, Wang Guozhong¹, Zhang Libin¹, 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 100054, China

Received:2019-12-22 Online:2020-06-21 Published:2020-06-17
Supported by:
This study was supported by Special Project of Capital Health Development (2018-2-7082).

摘要/Abstract

摘要： 目的利用光学相干断层成像（optical coherence tomography，OCT）对经皮桡动脉冠状动脉介入（transradial intervention，TRI）术后桡动脉无鞘区（non-sheathed radial artery，NSRA）急慢性损伤进行评估。方法 2016年2月至2017年9月有162例患者在OCT指导下完成TRI后对NSRA进行OCT检查，根据患者有无TRI史分为重复TRI组（n=31）和首次TRI组（n=131），对比两组急性损伤（内膜撕裂、夹层、穿孔、血栓和痉挛）发生率和慢性损伤指标差异，包括内膜面积、管腔狭窄率（percentage of lumen narrowing，% LN）、血管内膜与中膜厚度比值（intima-media ratio，IMR）和内膜厚度指数（intimal thickness index，ITI）。结果 NSRA急性损伤发生率为31.5%，重复TRI组患者NSRA总体急性损伤发生率明显高于首次TRI组（48.4% vs 27.5%，P=0.032），内膜撕裂（6.5% vs 5.3%，P=1.000）、夹层（9.7% vs 1.5%，P=0.075）、穿孔（3.2% vs 1.5%，P=1.000）、血栓（12.9% vs 6.9%，P=0.457）及痉挛（29.0% vs 16.0%，P=0.094）的发生率两组差异无统计学意义。重复TRI组患者内膜面积（0.59 mm² vs 0.46 mm²，P=0.011）、IMR（0.40 vs 0.28，P=0.001）和ITI（0.27 vs 0.22，P=0.012）明显大于首次TRI组，而% LN差异无统计学意义（31.70% vs 30.81%，P=0.244）。多因素Logistic回归分析显示，重复TRI是NSRA急性损伤发生的独立危险因素（OR=2.772，95%CI：1.053~7.301，P=0.039）。结论 TRI术后NSRA急性损伤发生率为31.5%，与首次TRI组相比，重复TRI组NSRA急性损伤发生率更高且慢性内膜增生显著，重复TRI是NSRA急性损伤发生的独立危险因素。

关键词: 桡动脉, 鞘管, 冠状动脉介入, 光学相干断层成像

Abstract: Objective To evaluate the acute and chronic effects of transradial intervention (TRI) on the non-sheathed radial artery (NSRA) by optical coherence tomography (OCT). Methods A total of 162 patients who underwent both OCT-guided TRI and NSRA OCT examination between February 2016 and September 2017 were enrolled. The patients were divided into the first TRI group (n=131) and the repeat TRI group (n=31). The incidence rate of acute injury including intimal tear, dissection, perforation, thrombus and spasm as well as the chronic injury indexes, including intimal area, percentage of lumen narrowing (%LN), intima-media ratio (IMR) and intimal thickness index (ITI), were compared between the two groups. Results The incidence of acute injury in NSRA was 31.5% in the repeat TRI group, significantly higher than that in the first TRI group (48.4% vs 27.5%, P=0.032). There was no significant difference in the incidence of intimal tear (6.5% vs 5.3%, P=1.000), dissection (9.7% vs 1.5%, P=0.075), perforation (3.2% vs 1.5%, P=1.000), thrombus (12.9% vs 6.9%, P=0.457), and spasm (29.0% vs 16.0%, P=0.094) between the two groups. Intimal area (0.59 mm² vs 0.46 mm², P=0.011), IMR (0.40 vs 0.28, P=0.001) and ITI (0.27 vs 0.22, P=0.012) of the patients in the repeat TRI group were significantly greater than those in the first TRI group, while%LN showed no difference (31.70% vs 30.81%, P=0.244). Multivariate Logistic regression analysis revealed that repeat TRI was an independent risk factor for acute NSRA injury (OR=2.772, 95%CI: 1.053-7.301, P=0.039). Conclusions The incidence of acute injury after TRI in NSRA was 31.5%. Compared with the first TRI group, the repeat TRI group has significantly higher incidence of acute injury and intimal hyperplasia. Repeat TRI is an independent risk factor for acute NSRA injury.

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

中图分类号:

R540.4

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.

Niu Dan, Hua Qi, Liu Zijing, Li Zixuan, Song Jiahui, Yan Rui, Wang Guozhong, Zhang Libin, Guo Jincheng. Comparison of acute and chronic non-sheathed radial artery injury between the first and repeat transradial intervention by optical coherence tomography[J]. Journal of Capital Medical University, 2020, 41(3): 464-469.

参考文献

[1] Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery[J]. N Engl J Med, 2018, 378(22):2069-2077.
[2] 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.
[3] 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.
[4] 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, 30:21-29.
[5] 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:e0185404.
[6] 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.
[7] 毕希乐.经前臂桡/尺动脉介入术后前臂动脉结构和功能研究[D].石家庄:河北医科大学,2016.
[8] Batchelor W, Dahya V, McGee D, et al. Ultrahigh-resolution ultrasound characterization of access site trauma and intimal hyperplasia following use of a 7F sheathless guide versus 6F sheath/guide combination for transradial artery PCI:results of the PRAGMATIC trial[J]. Am Heart J, 2018, 198:75-83.
[9] Horie K, Tada N, Isawa T, et al. Transradial intervention in patients with non-ST elevation acute coronary syndrome using one 4.0 Fr sheath and one sheathless guide catheter via a single puncture site:the 1-1-1 strategy[J]. J Invasive Cardiol, 2018, 30(9):316-323.
[10] Mitchell A, Fujisawa T, Mills N L, et al. Endothelial progenitor cell biology and vascular recovery following transradial cardiac catheterization[J]. J Am Heart Assoc, 2017, 6(11):e006610.

[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]	刘明明, 梁宇霆. 鞘管法子宫输卵管造影的临床价值[J]. 首都医科大学学报, 2020, 41(6): 982-985.
[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]	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.
[5]	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.
[6]	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.
[7]	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.
[8]	林涛, 魏欣, 徐晓薇, 马岩, 王蕊, 田俊萍, 郭晓彬, 陈步星. 可调弯鞘在心房颤动环肺静脉隔离术中的应用经验[J]. 首都医科大学学报, 2016, 37(1): 54-57.
[9]	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.
[10]	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.
[11]	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.
[12]	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.
[13]	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.
[14]	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.
[15]	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.

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

Comparison of acute and chronic non-sheathed radial artery injury between the first and repeat transradial intervention by optical coherence tomography

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