Kristić Ivica, Lukenda Josip
University Hospital Split, Division of Cardiology, Department of Internal Medicine, Split, Croatia.
J Invasive Cardiol. 2011 Dec;23(12):527-31.
Although transradial access (TRA) for coronary procedures has many advantages over the transfemoral approach, it's still not the dominant route used in coronary interventions. Radial artery spasm (RAS) is an important limitation of TRA. We performed a search of published literature to estimate the prevalence and possible risk factors of RAS in patients undergoing transradial coronary procedure. Nineteen published papers including 7197 patients were identified as relevant; reported incidence of RAS was 14.7% altogether. It varies depending upon the criteria used, on applied premedications, and on sheath or catheter selection. Use of hydrophilic coated sheaths and catheters can reduce the incidence of RAS to 1%, while intra-arterial application of verapamil (1.25-5 mg) and nitroglycerin (100-200 μg) can reduce the incidence of RAS up to 3.8%. We concluded that RAS is still problematic in transradial access, and that besides hydrophilic materials, the use of intra-arterial vasodilators remains mandatory in RAS prevention. However, the optimal spasmolytic cocktail is yet to be confirmed by valid spasm criteria.
尽管冠状动脉介入手术采用经桡动脉途径（TRA）相对于经股动脉途径有许多优势，但它仍不是冠状动脉介入治疗中使用的主要途径。桡动脉痉挛（RAS）是TRA的一个重要限制因素。我们检索了已发表的文献，以评估接受经桡动脉冠状动脉手术患者中RAS的发生率及可能的危险因素。共确定了19篇已发表的论文，涉及7197例患者；报道的RAS总发生率为14.7%。其发生率因所采用的标准、所用的术前用药以及鞘管或导管的选择而异。使用亲水涂层鞘管和导管可将RAS的发生率降至1%，而动脉内应用维拉帕米（1.25 - 5毫克）和硝酸甘油（100 - 200微克）可将RAS的发生率降低至3.8%。我们得出结论，在经桡动脉途径中，RAS仍然是个问题，并且除了亲水材料外，动脉内使用血管扩张剂对于预防RAS仍然是必要的。然而，最佳的解痉合剂仍有待通过有效的痉挛标准来证实。
