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在接受经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中使用单根桡动脉引导导管:一种门球时间优化策略。

A Single Transradial Guiding Catheter in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Door-to-Balloon Optimized Strategy.

作者信息

Cervantes-Nieto Jorge Antonio, Pimentel-Esparza Juan Andres, Gomez-Monterrosas Omar, Casillas-Gastelum Heidy Jaqueline, Fuentes Mendoza Juan Alan

机构信息

Cardiology, National Institute of Cardiology Ignacio Chávez, Mexico City, MEX.

Internal Medicine, Hospital Regional de Pemex en Salamanca, Salamanca, MEX.

出版信息

Cureus. 2023 Oct 10;15(10):e46802. doi: 10.7759/cureus.46802. eCollection 2023 Oct.

Abstract

Background Acute coronary syndrome (ACS) is the leading cause of morbidity and mortality worldwide. The different reperfusion strategies have evolved over the years, and efforts have been directed to reduce its complications. Among these strategies, the one that has shown the best results is percutaneous coronary intervention, which has significantly improved the survival and prognosis of these patients; however, this procedure is not free of complications since multiple factors are involved. Among them is the time of patient care from the time of diagnosis until the coronary reperfusion therapy is performed. Methodology In this study, we describe the experience in our center with the 6-French Ikari Left guide catheter as a strategy of radial angiography-angioplasty with a single catheter to reduce the care times of patients with acute ST-elevation myocardial infarction (STEMI) in our center and compare it with the series reported by other international centers since. To establish an alternative to the usual approach that consists of the use of Judkins catheters, diagnosis, and guiding. Results Our study showed a success rate for diagnostic angiography and percutaneous coronary intervention (PCI) with the 6- French Ikari Left catheter comparable to those obtained in other centers, even with lower complication rates than the usual approach with Judkins' Catheters. Conclusions The use of the 6-French Ikari Left catheter demonstrated shorter needle-device time and compared to other international series, it was shown to be shorter and related to shorter fluoroscopy time. Our study has a small sample and only included a highly selected population, which represents a limitation. This study is vulnerable to the different practices of the operators, with involvement in procedure time and use of contrast volume.

摘要

背景 急性冠状动脉综合征(ACS)是全球发病和死亡的主要原因。多年来,不同的再灌注策略不断发展,人们致力于减少其并发症。在这些策略中,显示出最佳效果的是经皮冠状动脉介入治疗,这显著改善了这些患者的生存率和预后;然而,该手术并非没有并发症,因为涉及多种因素。其中包括从诊断到进行冠状动脉再灌注治疗的患者护理时间。

方法 在本研究中,我们描述了我们中心使用6F伊卡里左冠状动脉导管作为一种采用单一导管进行桡动脉血管造影 - 血管成形术的策略,以减少我们中心急性ST段抬高型心肌梗死(STEMI)患者的护理时间,并将其与其他国际中心报道的系列进行比较。为常规方法(包括使用Judkins导管、诊断和引导)建立替代方案。

结果 我们的研究表明,使用6F伊卡里左冠状动脉导管进行诊断性血管造影和经皮冠状动脉介入治疗(PCI)的成功率与其他中心相当,甚至并发症发生率低于使用Judkins导管的常规方法。

结论 使用6F伊卡里左冠状动脉导管显示穿刺 - 器械操作时间更短,与其他国际系列相比,其操作时间更短且透视时间更短。我们的研究样本量小且仅纳入了高度选择的人群,这是一个局限性。本研究易受操作者不同操作习惯的影响,包括手术时间和造影剂用量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a1a/10635583/fd9ec596743a/cureus-0015-00000046802-i01.jpg

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本文引用的文献

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Fourth Universal Definition of Myocardial Infarction (2018).
Circulation. 2018 Nov 13;138(20):e618-e651. doi: 10.1161/CIR.0000000000000617.
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Transradial cardiac catheterization: a review of access site complications.
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