Department of Cardiology, Changi General Hospital, Singapore.
J Interv Cardiol. 2012 Jun;25(3):235-44. doi: 10.1111/j.1540-8183.2011.00710.x. Epub 2012 Feb 7.
Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients.
This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis.
TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 - 119.5) versus 98 (IQR 80.8 - 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 - 45.0) versus 37 (IQR 28.0 - 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups.
In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.
经桡动脉冠状动脉介入治疗（TRI）已广泛应用于 ST 段抬高型心肌梗死（STEMI）患者，但对于使用单一导管同时进行诊断性血管造影和介入治疗的文献报道有限。本研究旨在评估在 STEMI 患者中使用单一 Ikari 左（IL）导引导管进行 TRI 的可行性和结果。
这是一项回顾性研究，纳入了 2007 年 8 月至 2008 年 12 月期间连续 362 例 STEMI 患者。我们评估了使用单一 IL 进行 TRI 的可行性，并通过意向治疗分析比较了这种策略与传统经股动脉介入（TFI）的以下结果：（1）门到灌注时间，（2）总手术时间，（3）总透视时间，和（4）主要不良心脏事件（MACE）。
共尝试了 185 例 TRI。无桡动脉穿刺失败。使用单一 IL 进行原发性 TRI 的总体成功率为 96.9%，仅 2 例需要转为 TFI。与 TFI 相比，IL 组的中位门到灌注时间更短，分别为 90（IQR 76.0-119.5）与 98（IQR 80.8-120.5）分钟（P=0.07），手术时间更短，分别为 34（IQR 27.0-45.0）与 37（IQR 28.0-49.3）分钟（P=0.06）。TRI 组的透视时间中位数较长。两组的 MACE 发生率相当。
在经验丰富的中心，使用单一 IL 导管进行 STEMI 的 TRI 是一种可行且有效的方法，其结果与传统 TFI 相当。
