经桡动脉冠状动脉介入术后桡动脉急慢性损伤的评估
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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。
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 extracted2 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% vs44. 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.
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 extracted2 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% vs44. 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.
引文
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[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.
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[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 M ed,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.
[2] Valgimigli M,Frigoli E,Leonardi S,et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients w ith acute coronary syndrome(M ATRIX):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. 2018ESC/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 M ed,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.