University Hospital of North Staffordshire, Stoke-on-Trent, UK.
Am Heart J. 2013 Mar;165(3):317-24. doi: 10.1016/j.ahj.2012.10.015. Epub 2012 Dec 22.
Neurologic complications (NCs) are a rare but potentially devastating complication that may follow percutaneous coronary intervention (PCI). In recent years, there has been an increase in use of transradial access, driven by a developing body of evidence that favors its use over femoral access. Concerns have been raised, however, that transradial access may increase the risk of NC compared with transfemoral access. We aimed to investigate the influence of access site selection on the occurrence of NCs through a period of transition during which transradial access became the dominant route for PCI procedures performed in the United Kingdom.
We performed a retrospective analysis of the British Cardiovascular Intervention Society database between January 2006 and December 2010. The data were split into 2 cohorts based on access site. An NC was defined as a periprocedural ischemic stroke, hemorrhagic stroke, or transient ischemic attack occurring before hospital discharge. Binary logistic multivariate analysis was used to investigate the influence of access site utilization on NCs and adjust for measured confounding factors.
Between 2006 and 2010, the use of radial access increased from 17.2% to 50.8% of all PCI procedures. A total of 124,616 radial procedures and 223,476 femoral procedures were studied with a NC rate of 0.11% in each cohort. In univariate (odds ratio 1.01, 95% CI 0.82-1.24, P = .93) and multivariate analysis (odds ratio 0.99, 95% CI 0.79-1.23, P = .91), there was no significant association between the use of radial access and the occurrence of NCs.
These results suggest that radial access is not associated with an increased risk of clinically detected NCs, even during a period when there was a rapid evolution in the preferred access site for PCI in the United Kingdom. These are reassuring results, particularly for operators embarking on a change to radial access for PCI.
神经并发症（NCs）是一种罕见但可能具有破坏性的并发症，可能会在经皮冠状动脉介入治疗（PCI）后发生。近年来，由于越来越多的证据表明经桡动脉入路优于股动脉入路，经桡动脉入路的使用有所增加。然而，人们担心与股动脉入路相比，经桡动脉入路可能会增加 NC 的风险。我们旨在通过经桡动脉入路成为英国进行的 PCI 手术主要途径的过渡期，研究入路选择对 NC 发生的影响。
我们对 2006 年 1 月至 2010 年 12 月期间英国心血管介入学会数据库进行了回顾性分析。根据入路将数据分为 2 组。NC 定义为住院前发生的围手术期缺血性卒中、出血性卒中和短暂性脑缺血发作。采用二元逻辑多变量分析研究入路利用对 NC 的影响，并调整测量的混杂因素。
2006 年至 2010 年间，桡动脉入路使用率从所有 PCI 手术的 17.2%增加到 50.8%。共研究了 124616 例桡动脉手术和 223476 例股动脉手术，两组的 NC 发生率分别为 0.11%。在单变量（比值比 1.01，95%CI 0.82-1.24，P =.93）和多变量分析（比值比 0.99，95%CI 0.79-1.23，P =.91）中，桡动脉入路的使用与 NC 的发生之间均无显著关联。
这些结果表明，即使在英国 PCI 首选入路迅速演变的时期，桡动脉入路也不会增加临床检测到的 NC 的风险。这些结果令人安心，特别是对于开始进行桡动脉入路 PCI 的操作者。
