Achenbach Stephan, Ropers Dieter, Kallert Lisa, Turan Nesrin, Krähner Robert, Wolf Tobias, Garlichs Christoph, Flachskampf Frank, Daniel Werner G, Ludwig Josef
Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany.
Catheter Cardiovasc Interv. 2008 Nov 1;72(5):629-35. doi: 10.1002/ccd.21696.
The transradial (TR) approach has potentially lower complication rates than transfemoral (TF) approach coronary angiography. However, it may be technically more challenging, especially in elderly patients with alterations in vascular anatomy. We thus determined success rates, procedural data, and complication rates of TR angiography in comparison to the TF approach in elderly patients in a randomized, prospective trial.
Four hundred consecutive patients >or=75 years with known or suspected coronary artery disease were included in the study. After exclusion of 93 patients with contraindications to the radial approach, 152 patients were randomized to the TR and 155 to TF coronary angiography and intervention. In 13 patients randomized to TR, cross-over to TF was necessary (9%). Total examination time was significantly longer for the TR approach (18.1 vs. 15.0 min, P = 0.009), but no difference was found for fluoroscopy time, number of catheters used, or amount of contrast agent. The rate of major complications (bleeding requiring surgery or transfusion, stroke) was 0% for TR and 3.2% for TF approach (P < 0.001). Minor complications occurred in 1.3% versus 5.8% of patients (P < 0.001).
In elderly patients, TR coronary angiography and intervention has a high technical success rate and lower complication rates than the TF approach.
经桡动脉（TR）途径冠状动脉造影的并发症发生率可能低于经股动脉（TF）途径。然而，其技术难度可能更大，尤其是在血管解剖结构改变的老年患者中。因此，我们在一项随机、前瞻性试验中，比较了老年患者经桡动脉造影与经股动脉造影的成功率、操作数据及并发症发生率。
本研究纳入了400例年龄≥75岁、已知或疑似患有冠状动脉疾病的患者。在排除93例有桡动脉途径禁忌证的患者后，152例患者被随机分配接受经桡动脉冠状动脉造影及干预，155例患者接受经股动脉冠状动脉造影及干预。在随机分配至经桡动脉组的13例患者中（9%），有必要转为经股动脉途径。经桡动脉途径的总检查时间显著更长（18.1分钟对15.0分钟，P = 0.009），但在透视时间、使用导管数量或造影剂用量方面未发现差异。经桡动脉途径的主要并发症（需要手术或输血的出血、中风）发生率为0%，经股动脉途径为3.2%（P < 0.001）。次要并发症在患者中的发生率分别为1.3%和5.8%（P < 0.001）。
在老年患者中，经桡动脉冠状动脉造影及干预具有较高的技术成功率，且并发症发生率低于经股动脉途径。
