Liu T, Zhou P, Chen H
Department of Cardiology, First Affiliated Hospital of Chengdu Medical College, Key Laboratory for Aging and Steady State of Universities in Sichuan Province, Chengdu 610500, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Jun 24;46(6):458-463. doi: 10.3760/cma.j.issn.0253-3758.2018.06.009.
To observe the effect of 5 F Tiger Ⅰ catheter shaping technique in complex coronary angiography. This study was a single-center, single-blind, randomized, parallel controlled trial and subjects were consecutively enrolled if the first coronary angiography could not be completed by 5 F Tiger Ⅰ catheterization at our department from January 2016 to June 2017 (159). The subjects were divided into 2 groups using a random number table method: 79 patients in the control group, and 6 F Judkins and Amplatz catheters were used to perform coronary angiography through the radial artery; 80 patients in the experimental group, and 5 F Tiger Ⅰ shaping technique were used to perform coronary angiography through the radial artery. The reasons of complex coronary angiography were divided into 3 categories: class A referred the abnormal origin of left and right coronary arteries;class B referred left or right coronary artery opening higher or lower than conventional openings or opening downwards and upwards; class C referred the ascending aorta abnormalities (longer, wider, or shorter and thinner). Coronary angiography and operative complications were compared between the 2 groups. X-ray exposure time of coronary angiography ((4.17±1.67) min vs. (4.78±1.51) min, 0.017), X-ray dose (230 (175, 275) mGy vs. 267 (230, 321) mGy, 0.001), contrast agent dose ((54.6±8.2) ml vs. (61.8±7.9) ml, 0.001), operative time (21.6 (18.9, 25.4) min vs. 26.8 (23.4, 31.4) min, 0.001), and number of catheters used (1.30±0.56 vs. 2.47±0.57, 0.001) were all less in experimental group than in the control group. There was no significant difference in success rate of the coronary angiography between the experimental group and the control group(97.5% (78/80) vs. 98.7% (78/79), 0.567). There was no significant difference in the incidence of radial artery spasm (2.5% (2/80) vs. 5.1% (4/79), 0.396) and coronary artery spasm (1.3% (1/80) vs. 3.8% (3/79), 0.639). In class A and C subjects, X-ray exposure time, X-ray dose, and operation time were similar between the experimental and control groups (all 0.05), while the number of catheters used was less in the experimental group than in the control group (0.01). In the class C subjects, dose of contrast agent used was significantly lower in the experimental group than in the control group (0.001). In theclass B subjects, the X-ray dose, contrast agent dose, operation time, and number of catheters used were all less in the experimental group than in the control group (all 0.01), and there was no significant difference in X-ray exposure time between the 2 groups (0.192). For complex coronary angiography, the imaging success rate and safety of the 5 F Tiger Ⅰshaping catheter is comparable to that of 6 F Judkins and Amplatz catheters.
观察5F TigerⅠ导管塑形技术在复杂冠状动脉造影中的应用效果。本研究为单中心、单盲、随机、平行对照试验，选取2016年1月至2017年6月在我科首次行冠状动脉造影时不能通过5F TigerⅠ导管完成操作的患者（159例）连续纳入研究。采用随机数字表法将患者分为2组：对照组79例，采用6F Judkins和Amplatz导管经桡动脉行冠状动脉造影；试验组80例，采用5F TigerⅠ导管塑形技术经桡动脉行冠状动脉造影。复杂冠状动脉造影的原因分为3类：A类为左、右冠状动脉起源异常；B类为左或右冠状动脉开口高于或低于常规开口或开口向下及向上；C类为升主动脉异常（长、宽或短、细）。比较2组冠状动脉造影情况及手术并发症。试验组冠状动脉造影的X线曝光时间（（4.17±1.67）min对（4.78±1.51）min，P=0.017）、X线剂量（230（175，275）mGy对267（230，321）mGy，P=0.001）、造影剂用量（（54.6±8.2）ml对（61.8±7.9）ml，P=0.001）、手术时间（21.6（18.9，25.4）min对26.8（23.4，31.4）min，P=0.001）及使用导管数量（1.30±0.56对2.47±0.57，P=0.001）均少于对照组。试验组与对照组冠状动脉造影成功率差异无统计学意义（97.5%（78/80）对98.7%（78/79），P=0.567）。桡动脉痉挛发生率（2.5%（2/80）对5.1%（4/79），P=0.396）及冠状动脉痉挛发生率（1.3%（1/80）对3.8%（3/79），P=0.639）差异无统计学意义。在A类和C类患者中，试验组与对照组的X线曝光时间、X线剂量及手术时间差异均无统计学意义（均P>0.05），但试验组使用导管数量少于对照组（P=0.01）。在C类患者中，试验组造影剂用量明显低于对照组（P=0.001）。在B类患者中，试验组的X线剂量、造影剂用量、手术时间及使用导管数量均少于对照组（均P=0.01），2组X线曝光时间差异无统计学意义（P=0.192）。对于复杂冠状动脉造影，5F TigerⅠ塑形导管的成像成功率及安全性与6F Judkins和Amplatz导管相当。
