摘要
目的分析贵州省人民医院经桡动脉行经皮冠状动脉介入治疗(PCI)过程中发生支架变形或脱载的原因及处理措施。方法收集2005年1月至2018年5月所有经桡动脉行PCI患者,调取发生支架变形或脱载病例影像学资料,2名有经验的PCI医师根据影像学资料、病历资料及术者叙述,分析发生支架变形或脱载的主要原因及处理措施。结果共入选经桡动脉PCI患者11 132例,发生支架变形或脱载10例,发生率0.90‰。支架变形或脱载原因(可能多原因并存):血管迂曲、成角和钙化(8例),导引导管与冠状动脉同轴性差(4例),深吸气导致支架异位释放后"逃逸"(1例),支架通过已释放支架侧孔时剐蹭(1例)。处理措施:冠状动脉内支架挤压(1例),冠状动脉内原位释放(1例),桡动脉释放(2例),经皮小切口血管钳夹取脱载至桡动脉穿刺口支架(1例),对侧桡动脉圈套器降主动脉抓捕(1例),同侧锁骨下动脉圈套器抓捕脱载"逃逸"支架(1例),同侧腋/肱动脉圈套器抓捕(3例)。结论支架变形或脱载是经桡动脉PCI少见并发症,血管迂曲、成角、钙化及导管同轴性差是主要原因。处理措施应根据实际情况灵活掌握,回撤至腋/肱动脉圈套器捕获是简便、安全的选择。
Objective To discuss the causes and managements of stent deformation or dislodgement occurring in transradial percutaneous coronary intervention(PCI)in Guizhou Provincial People’s Hospital of China.Methods The patients,who received transradial PCI during the period from January 2005 to May2018,were collected,and the imaging data of patients with stent deformation or dislodgement were obtained.Based on the imaging findings,the medical records and the description of the operator,the main causes of stent deformation or dislodgement were analyzed by two experienced doctors involved in PCI and the treatment measures were evaluated.Results A total of 11132 patients who received transradial PCI were enrolled in this study.Stent deformation or dislodgement occurred in 10 patients,the incidence was 0.90‰.The causes of stent deformation or dislodgement(possibly coexisting multiple reasons at the same time)included tortuosity,angulation and calcification of coronary artery(n=8),poor coaxality between guiding catheter and coronary artery(n=4),stent"escape"from guiding wire after ectopic release caused by deep inspiration(n=1),and scratch of stent as passing through the side hole of a released stent(n=1).The treatment measures were as follows:compression by another stent in coronary artery(n=1),intracoronary in situ release(n=1),release in radial artery(n=2),clamping stent by forceps inserted through a tiny incision in the skin and pulling the stent out through radial artery puncture site(n=1),using a snare inserted via contralateral radial artery to capture the stent in the descending aorta(n=1),using a snare inserted via ipsilateral subclavian artery to capture the"escaped"stent(n=1),and using a snare inserted via ipslateral axillary/brachial artery to capture the"escaped"stent(n=3).Conclusion Stent deformation or dislodgement is a rare complication in performing transradial PCI,and vascular tortuosity,angulation,calcification and poor coaxality between guiding catheter and coronary artery are the main causes.The handli
作者
李宗庄
张陈匀
岳峰
韦方
刘志琴
田野
谭洪文
吴强
LI Zongzhuang;ZHANG Chenyun;YUE Feng;WEI Fang;LIU Zhiqin;TIAN Ye;TAN Hongwen;WU Qiang(Department of Cardiologyy Guizhou Provincial Peopled Hospital,Guiyang,Guizhou Province 550002,China)
出处
《介入放射学杂志》
CSCD
北大核心
2019年第6期521-524,共4页
Journal of Interventional Radiology
基金
贵州省高层次创新型人才“千”层次培养计划项目(GZSYQCC2015-007)
贵州省心血管疾病临床医学研究中心科技平台及人才团队建设计划项目(2017-5405)
国家临床重点专科建设项目(2013-544)
关键词
经皮冠状动脉介入治疗
支架变形
支架脱载
肱动脉
腋动脉
percutaneous coronary intervention
stent deformation
stent dislodgement
brachial artery
axillary artery
