Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
J Interv Cardiol. 2022 Nov 17;2022:3249745. doi: 10.1155/2022/3249745. eCollection 2022.
The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear.
Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time.
Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, < 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, =0.007), hypertension (94.7% vs. 75.6%, =0.02), and subclavian artery calcification (73.7% vs. 34.2%, < 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time ( = -0.51, < 0.001) and total procedural time ( = -0.32, =0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees ( = 0.45, < 0.001).
Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.
经皮冠状动脉介入治疗（PCI）过程中左锁骨下动脉迂曲对急性冠状动脉综合征（ACS）患者的影响尚不清楚。
纳入 245 例 ACS 患者（2019 年 11 月至 2021 年 5 月），其中 79 例行左桡动脉入路（LRA）PCI。我们在 CT 影像冠状位测量左锁骨下动脉角度作为迂曲的指标，并研究该角度与临床变量和手术时间的关系。
左锁骨下动脉角度中位数<70 度（严重迂曲）的患者年龄较大（75.4±11.7 岁比 62.9±12.3 岁，<0.001），女性比例较高（42.1%比 14.6%，=0.007），高血压（94.7%比 75.6%，=0.02）和锁骨下动脉钙化（73.7%比 34.2%，<0.001）的比例也较高。左锁骨下动脉角度与鞘管插入至首次球囊时间（ = -0.51，<0.001）和总手术时间（ = -0.32，=0.004）呈负相关。多元线性回归分析显示，鞘管插入至首次球囊时间的自然对数值与左锁骨下动脉角度<70 度相关（ = 0.45，<0.001）。
本研究表明，左锁骨下动脉角度较低作为 LRA 迂曲的标志物，与 PCI 过程中鞘管插入至球囊时间和随后整个手术时间较长密切相关。
