目的 研究应用经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝经桡动脉环完成冠状动脉造影的可行性。方法 2012-01至2012-12我院行经桡动脉冠状动脉造影2600例,对超滑导丝推送困难或遇到阻力者通过造影导管行桡动脉或上肢动脉造影,对发现的桡动脉环随机分为两组,PTCA导丝组改用PTCA导丝尝试通过桡动脉环完成冠脉造影,改股动脉组直接改为股动脉入路行冠脉造影,比较两组成功率、操作时间、放射线剂量(dose area product, DAP)、造影剂用量情况等。结果 经桡动脉造影确认桡动脉环52例,两组患者完成冠脉造影成功率差异无统计学意义(92% vs 100%,P=0.15),PTCA导丝组操作时间、放射线剂量高于改股动脉组[(922.8±124.2) s vs (699.2±99.5) s,P<0.001; (27288.1±6420.2 ) mGy/cm² vs (22711.9±4850.4 )mGy/cm²,P<0.05 ],造影剂用量差异无统计学意义[(49.5±5.9) ml vs (45.1±6.2) ml,P＞0.05]。结论 经桡动脉造影遇到桡动脉环时通过改用PTCA导丝仍可顺利完成冠脉造影,一定程度增加操作时间及放射线剂量。

Objective To studythe feasibility of the transradial approach for coronary angiography using PTCA guidewire through the radioulnar loop. Methods From January to December in 2012,a total of 2600 patients undergoing transradial coronary angiography were recruited.Retrogarde radial arteriography was performed when hydrophilic wire could not cross the radial artery, if we found radioulnar loop ,we randomized the patients into two groups,one group try to cross the radioulnar loop with PTCA guidewire,another group revert to transfemoral approach. Patient demographics,procedure duration, amount of contrast media usage, and dose area product(DAP) were recorded. Results radioulnar loops were noted in 52 patients(2 %),the success rate was notsignificantly different, procedue duration was longer in PTCA guidewire group, DAP was higher in PTCA guidewire group, the amount of contrast media usage and vascular complication rate was not significant. Conclusions Although radioulnar loop prolongs the procedure duration and increases DAP, the success rate is nonsignifican.