Xu Lili, Cao Jiatian, Zhang Meng, Yang Hongbo, Huang Zheyong, Song Yanan, Li Chenguang, Dai Yuxiang, Yao Kang, Wang Xiangfei, Zhang Feng, Qian Juying, Ge Junbo
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
National Clinical Research Center for Interventional Medicine, Shanghai, China.
Front Cardiovasc Med. 2022 Mar 1;9:730648. doi: 10.3389/fcvm.2022.730648. eCollection 2022.
Current guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle-angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.
Patients undergoing a transradial coronary procedure in our team from August 2015 to June 2020 were retrospectively investigated. We compared the demographic and interventional characteristics of 1,457 patients receiving advancement of unmodified guidewires (Traditional group) and 1,322 patients receiving advancement of the knuckle guidewire (Knuckle group). Afterwards we included 239 patients and randomized them according to a random number table to either the unmodified or the knuckle guidewire to further confirm the efficiency and safety of knuckle guidewire advancement.
In the retrospective analysis, unwilling passage of guidewire into branches occurred more in the Traditional group than in the Knuckle group (9.5 vs. 0.08%, < 0.001). Two patients in the Traditional group experienced guidewire-associated perforation. One patient was treated with covered stent for internal mammarian artery perforation, while the other was managed with compression for brachial branch perforation. In the randomized controlled study, unwilling passage of guidewire also occurred more in the Traditional group (10.8 vs. 1%, < 0.001). Median duration of guidewire advancement from the sheath to aortic root significantly decreased from 33 seconds in the Traditional group to 21 seconds in the Knuckle group.
Active knuckle angle guidewire represented a novel method to prevent unwilling passage and associated perforation with efficiency improvement and a reduction in radiation exposure.
目前用于桡动脉冠状动脉造影的导丝存在通过困难或分支损伤的缺陷。本研究旨在探讨一种新型主动关节角0.035英寸亲水导丝在桡动脉冠状动脉造影中的安全性和有效性。
回顾性研究2015年8月至2020年6月在本团队接受桡动脉冠状动脉手术的患者。我们比较了1457例接受未改良导丝推进的患者（传统组）和1322例接受关节导丝推进的患者（关节组）的人口统计学和介入特征。之后，我们纳入239例患者，并根据随机数字表将他们随机分为未改良导丝组或关节导丝组，以进一步证实关节导丝推进的有效性和安全性。
在回顾性分析中，传统组导丝不愿进入分支的情况比关节组更常见（9.5%对0.08%，<0.001）。传统组有2例患者发生导丝相关穿孔。1例患者因乳内动脉穿孔接受覆膜支架治疗，另1例因肱动脉分支穿孔接受压迫治疗。在随机对照研究中，传统组导丝不愿进入分支的情况也更多见（10.8%对1%，<0.001）。导丝从鞘管推进至主动脉根部的中位时间从传统组的33秒显著缩短至关节组的21秒。
主动关节角导丝是一种预防导丝不愿进入及相关穿孔的新方法，可提高效率并减少辐射暴露。
