Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece.
Catheter Cardiovasc Interv. 2011 Apr 1;77(5):649-54. doi: 10.1002/ccd.22688.
Transradial coronary catheterization has emerged over the last years as a favorable catheterization practice, based on evidence that it is associated with less vascular complications and shorter hospital stays. However, access site crossover appears to be more frequent when the initial route is the transradial one, one of the main reasons being arterial spasm. We hypothesized that radial flow-mediated dilation (FMD) measurements could be used as a preprocedural method to assess the likelihood of arterial spasm.
The study population consisted of patients scheduled for transradial diagnostic catheterization in whom ad hoc percutaneous coronary intervention (PCI) was performed. FMD was measured 1-2 days before PCI. The primary endpoint of the study was operator-defined (operators were blinded as to the FMD results) radial artery spasm.
A total of 172 patients (110 male, age 65.3 ± 9) were included. Radial artery spasm was recorded in 13 patients (7.6%). FMD showed a very significant univariate association with the occurrence of spasm (P < 0.001) and was the most important predictor of spasm in the multivariate logistic regression analysis (beta -3.15; P < 0.001), followed by baseline radial artery diameter (P = 0.04), the number of catheters used (P = 0.049) and the administered volume of contrast medium (P = 0.017).
Preprocedural FMD is a significant predictor of arterial spasm before elective transradial PCI. It is a low cost, safe, and feasible noninvasive modality, whose results might be taken into account when deciding on the vascular access route for an elective procedure, the size of sheaths or catheters to be used or the intensity of antispasm medication.
近年来，经桡动脉冠状动脉造影术已成为一种有利的导管插入术，因为它与较少的血管并发症和较短的住院时间有关。然而，当初始途径是经桡动脉途径时，似乎更频繁地出现入路部位交叉，其中主要原因之一是动脉痉挛。我们假设，桡动脉血流介导的扩张（FMD）测量可作为一种术前方法来评估动脉痉挛的可能性。
研究人群包括计划经桡动脉进行诊断性导管插入术的患者，其中进行了专门的经皮冠状动脉介入治疗（PCI）。FMD 在 PCI 前 1-2 天测量。该研究的主要终点是操作者定义的（操作者对 FMD 结果不知情）桡动脉痉挛。
共纳入 172 例患者（110 例男性，年龄 65.3±9 岁）。13 例患者（7.6%）记录到桡动脉痉挛。FMD 与痉挛的发生具有非常显著的单变量相关性（P<0.001），并且在多变量逻辑回归分析中是痉挛的最重要预测因素（β-3.15；P<0.001），其次是基线桡动脉直径（P=0.04）、使用的导管数量（P=0.049）和施用的造影剂体积（P=0.017）。
术前 FMD 是择期经桡动脉 PCI 前动脉痉挛的重要预测指标。它是一种低成本、安全且可行的非侵入性方法，在决定择期手术的血管入路、要使用的鞘管或导管的大小或抗痉挛药物的强度时，可以考虑其结果。
