赵学强,潘金玉,姚玉才,李佳旻,郑飞

• 1:山东第一医科大学第一附属医院(山东省千佛山医院)心血管内科

摘要(Abstract)：

目的 对通过360°迂曲（环状迂曲）桡动脉完成冠状动脉介入诊疗操作进行初步探讨。方法 回顾性分析2015年1月1日至2023年6月30日山东第一医科大学第一附属医院15例环状迂曲右桡动脉的患者成功经桡动脉路径完成冠状动脉介入诊疗，并对经环状迂曲桡动脉的操作进行了总结。结果 本研究中15例患者均通过环状迂曲桡动脉完成了冠状动脉造影（CAG）；对于存在环状迂曲桡动脉的患者经迂曲桡动脉行经皮冠状动脉介入治疗（PCI）时，通过经皮冠状动脉腔内成形术导丝结合直径2.0mm球囊（6～8atm膨胀状态）辅助指引导管通过环状迂曲桡动脉后，交换为J形造影导丝将迂曲桡动脉部分拉直的状态下完成后续的CAG和PCI。左侧冠状动脉及右侧冠状动脉均可以通过该技术完成PCI，术后未出现前臂血肿及血管破裂等并发症。结论 导丝联合球囊的技术能够成功辅助导管通过环状迂曲桡动脉完成冠状动脉介入诊疗。

关键词(KeyWords)： 桡动脉;冠状动脉粥样硬化性心脏病;冠状动脉造影;冠状动脉腔内成形术;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 山东省医药卫生科技发展计划项目（2016WS0504）;; 山东省自然科学基金青年基金项目（BS2014SW011、ZR2020QH028）

作者(Author): 赵学强,潘金玉,姚玉才,李佳旻,郑飞

参考文献(References)：

• [1]陈焱,赵帅,杨丽,等.经皮冠状动脉介入治疗对老年多支慢性完全闭塞病变患者生活质量的影响[J].中国介入心脏病学杂志,2023,31(8):570-578.DOI:10.3969/j.issn.1004-8812.2023.08.002.
• [2]Campeau L.Percutaneous radial artery approach for coronary angiography[J].Cathet Cardiovasc Diagn,1989,16(1):3-7.DOI:10.1002/ccd.1810160103.
• [3]Kiemeneij F,Laarman GJ,Odekerken D,et al.A randomized comparison of percutaneous transluminal coronary angioplasty by the radial,brachial and femoral approaches:the access study[J].J Am Coll Cardiol,1997,29(6):1269-1275,DOI:10.1016/s0735-1097(97)00064-8.
• [4]Lawton JS,Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI guideline for coronary artery revascularization:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].Circulation,2022,145(3):e4-e17.DOI:10.1161/CIR.0000000000001039.
• [5]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.DOI:10.1016/S0140-6736(18)31714-8.
• [6]Kolkailah AA,Alreshq RS,Muhammed AM,et al.Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease[J].Cochrane Database Syst Rev,2018,4(4):CD012318.DOI:10.1002/14651858.CD012318.pub2.
• [7]Jolly SS.Yusuf S,Cairns J,et al.Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes(RIVAL):a randomised,parallel group,multicentre trial[J].Lancet,2011,377(9775):1409-1420.DOI:10.1016/S0140-6736(11)60404-2.
• [8]Shoji S,Kohsaka S,Kumamaru H,et al.Cost reduction associated with transradial access in percutaneous coronary intervention:a report from a Japanese nationwide registry[J].Lancet Reg Health West Pac,2022,28:100555.DOI:10.1016/j.lanwpc.2022.100555.
• [9]Lo TS,Nolan J,Fountzopoulos E,et al.Radial artery anomaly and its influence on transradial coronary procedural outcome[J].Heart,2009,95(5):410-415.DOI:10.1136/hrt.2008.150474.
• [10]Nie B,Zhou YJ,Li GZ,et al.Clinical study of arterial anatomic variations for transradial coronary procedure in Chinese population[J].Chin Med J(Engl),200 9,122(18):2097-2102.DOI:10,3760/cma.j.issn.0366-6999.2009.18.004.
• [11]杨虹波,曹嘉添,张峰,等.经桡动脉路径行冠状动脉造影导管打折预防方法的对比分析[J].中国介入心脏病学杂志,2022,30(8):585-589.DOI:10,3969/j,issn.1004-8812,2022.08.004.
• [12]Li H,Chen X,Sha S,et al.Correlation of a guidewire maximum insertion length with tortuous radial artery and the success rate during transra dial coronary angiography[J].BMC Cardiovasc Disord,2022,22(1):479.DOI:10.1186/s12872-022-02933-x.
• [13]李琪,王伟民,刘健,等.冠状动脉介入治疗对不稳定型心绞痛患者心功能和中长期预后的影响[J].中国介入心脏病学杂志,2022,30(9):672-676.DOI:10.3969/j.issn.1004-8812.2022.09.006.
• [14]Sanghvi K,Kurian D,Coppola J.Transradial intervention of iliac and superficial femoral artery disease is feasible[J].J Interv Cardiol,2008,21(5):385-387.DOI:10.1111/j.1540-8183.2008.00384.x.
• [15]Patel T,Shah S,Ranjan A,et al.Contralateral transradial approach for carotid artery stenting:a feasibility study[J].Catheter Cardiovasc Interv,2010,75(2):268-275.DOI:10.1002/ccd.22159.
• [16]Mehta SR,Jolly SS,Cairns J,et al.Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation[J].J Am Coll Cardiol,2012,60(24):2490-2499.DOI:10,1016/j.jacc.2012.07.050.
• [17]Romagnoli E,Biondi-Zoccai G,Sciahbasi A,et al.Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome:the RIFLE-STEACS(Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome)study[J].J Am Coll Cardiol,2012,60(24):2481-2489.DOI:10.1016/j.jacc.2012.06.017.
• [18]Yoo BS,Yoon J,Ko JY,et al.Anatomical consideration of the radial artery for transradial coronary procedures:arterial diameter,branching anomaly and vessel tortuosity[J].Int J Cardiol,2005,101(3):421-427,DOI:10,1016/j.ijcard.2004.03.061.
• [19]Valsecchi O,Vassileva A,Musumeci G,et al.Failure of transradial approach during coronary interventions:anatomic considerations[J].Catheter Cardiovasc Interv,2006,67(6):870-878.DOI:10.1002/ccd.20732.
• [20]Yokoyama N,Takeshita S,Ochiai M,et al.Anatomic variations of the radial artery in patients undergoing transradial coronary intervention[J].Catheter Cardiovasc Interv,2000,49(4):357-362,DOI:10.1002/(sici)1522-726x(200004)49:4<357::aid-ccdl>3.0.co;2-z.
• [21]Stella PR,Kiemeneij F,Laarman GJ,et al.Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty[J].Cathet Cardiovasc Diagn,1997,40(2):156-158.DOI:10.1002/(sici)1097-0304(199702)40:2<156::aid-ccd7>3.0.co;2-a.
• [22]Kiemeneij F,Laarman GJ,de Melker E.Transradial artery coronary angioplasty[J].Am Heart J,1995,129(1):1-7.DOI:10.1016/0002-8703(95)90034-9.