桡动脉与股动脉入路对辐射剂量的影响及操作量的重要性：多中心随机 RIVAL 试验的亚研究。
Effect of radial versus femoral access on radiation dose and the importance of procedural volume: a substudy of the multicenter randomized RIVAL trial.
机构信息
Department of Medicine, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.
出版信息
JACC Cardiovasc Interv. 2013 Mar;6(3):258-66. doi: 10.1016/j.jcin.2012.10.016.
OBJECTIVES
The authors sought to compare the radiation dose between radial and femoral access.
BACKGROUND
Small trials have shown an increase in the radiation dose with radial compared with femoral access, but many were performed during the operators' learning curve of radial access.
METHODS
Patients were randomized to radial or femoral access, as a part of the RIVAL (RadIal Vs. femorAL) trial (N = 7,021). Fluoroscopy time was prospectively collected in 5740 patients and radiation dose quantified as air kerma in 1,445 patients and dose-area product (DAP) in 2,255 patients.
RESULTS
Median fluoroscopy time was higher with radial versus femoral access (9.3 vs. 8.0 min, p < 0.001). Median air kerma was nominally higher with radial versus femoral access (1,046 vs. 930 mGy, respectively, p = 0.051). Median DAP was not different between radial and femoral access (52.8 Gy-cm(2) vs. 51.2 Gy·cm(2), p = 0.83). When results are stratified according to procedural volume, air kerma was increased only in the lowest tertile of radial volume centers (low 1,425 vs. 1,045 mGy, p = 0.002; middle 987 vs. 958 mGy, p = 0.597; high 652 vs. 621 mGy, p = 0.403, interaction p = 0.026). Multivariable regression showed procedural volume was the greatest independent predictor of lower air kerma dose (ratio of geometric means 0.55; 95% confidence interval 0.49 to 0.61 for highest-volume radial centers).
CONCLUSIONS
Radiation dose as measured by air kerma was nominally higher with radial versus femoral access, but differences were present only in lower-volume centers and operators. High-volume centers have the lowest radiation dose irrespective of which access site approach that they use. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273).
目的
作者旨在比较经桡动脉和股动脉入路的辐射剂量。
背景
小样本研究显示，与股动脉入路相比，经桡动脉入路的辐射剂量增加，但其中许多研究是在操作者学习经桡动脉入路的过程中进行的。
方法
患者被随机分配至桡动脉或股动脉入路，这是 RIVAL（桡动脉与股动脉）试验的一部分（N=7021）。在 5740 例患者中前瞻性采集透视时间，在 1445 例患者中量化空气比释动能，在 2255 例患者中量化剂量面积乘积（DAP）。
结果
与股动脉入路相比，桡动脉入路的透视时间中位数更高（9.3 分钟 vs. 8.0 分钟，p<0.001）。与股动脉入路相比，桡动脉入路的空气比释动能中位数略高（分别为 1046 毫戈瑞 vs. 930 毫戈瑞，p=0.051）。桡动脉与股动脉入路的 DAP 中位数无差异（52.8 Gy·cm² vs. 51.2 Gy·cm²，p=0.83）。当根据操作量对结果进行分层时，仅在桡动脉量最低三分位的中心发现空气比释动能增加（低 1425 毫戈瑞 vs. 1045 毫戈瑞，p=0.002；中 987 毫戈瑞 vs. 958 毫戈瑞，p=0.597；高 652 毫戈瑞 vs. 621 毫戈瑞，p=0.403，交互作用 p=0.026）。多变量回归显示，操作量是空气比释动能最低的独立预测因子（几何均数比 0.55；95%置信区间 0.49 至 0.61，对于最高量桡动脉中心）。
结论
以空气比释动能衡量，与股动脉入路相比，经桡动脉入路的辐射剂量略高，但仅在低量中心和操作者中存在差异。高量中心无论使用哪种入路，其辐射剂量均最低。（经桡动脉与经股动脉经皮冠状动脉介入治疗（PCI）入路途径治疗不稳定型心绞痛或心肌梗死伴侵入性策略患者的随机试验 [RIVAL]；NCT01014273）。
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