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目的:比较经股动脉和经桡动脉途径介入治疗冠状动脉慢性闭塞性病变的可行性和安全性。方法:选择2011年1月至2012年8月南京市第一医院收治的325例因为冠状动脉慢性闭塞性病变行经皮冠状动脉介入治疗的患者为研究对象,根据手术途径分为经桡动脉治疗(n=211)和经股动脉(n=114)组,回顾性分析和比较患者的基线特征、病变特征、手术经过和手术相关并发症。结果:经桡动脉和经股动脉组手术成功率分别为79.62%和80.70%(P>0.05)。两组患者的性别、年龄、危险因素(高血压、糖尿病及高脂血症)以往PCI及CABG手术史及冠心病临床表现比较均无统计学差别(均P>0.05);两组患者的慢性闭塞性病变病变数量、术中主动脉内球囊反搏(intra-aortic balloon pump,IABP)使用率、术后TIMI血流、手术时间、冠状动脉穿孔并发症的发生率比较无统计学差别(均P>0.05),但经股动脉手术组较经桡动脉组术中血管内超声(intravascular ultrasound,IVUS)的使用率更高(57.01%vs45.02%,P=0.039)。结论:经桡动脉PCI治疗冠状动脉慢性闭塞性病变更安全、有效,其IVUS的使用率低于经股动脉PCI治疗,但对于复杂慢性闭塞性病变病变术者可能更倾向于采用经股动脉途径。
Objective: To compare the feasibility and safety of trans-arterial and transradial approaches in the treatment of chronic obliterative coronary artery disease. Methods: From January 2011 to August 2012, the first hospital in Nanjing 325 cases of patients with chronic coronary artery occlusive disease undergoing percutaneous coronary intervention for the study, according to the surgical approach is divided into radial artery treatment ( n = 211) and transsphenoidal (n = 114) groups were retrospectively analyzed and compared for baseline characteristics of patients, lesion characteristics, surgical procedures, and surgery-related complications. Results: The success rate of transradial and trans-femoral arteries was 79.62% and 80.70% respectively (P> 0.05). There was no significant difference between the two groups in the gender, age, risk factors (hypertension, diabetes and hyperlipidemia) in the past history of PCI and CABG surgery and clinical manifestations of coronary heart disease (all P> 0.05) The number of occlusive lesions, the intra-aortic balloon pump (IABP) usage, postoperative TIMI flow, operative time, and the incidence of coronary perforation complications were not statistically different (P> 0.05). However, intra-arterial intra-arterial ultrasound (IVUS) was more frequently used in the femoral artery surgery group (57.01% vs 45.02%, P = 0.039). CONCLUSIONS: Transradial PCI is more safe and effective for the treatment of chronic obliterative coronary artery disease. The IVUS use rate is lower than that of PCI through femoral artery. However, it may be more appropriate to use the femoral artery approach for patients with complicated chronic occlusive disease.