Yang Jianmin, Wang Ningfu, Tong Xiaoshan, Ye Xianhua, Zhou Liang, Tong Guoxin, Shen Yun, Lv Shuzheng
J Cardiothorac Surg. 2014 Dec 5;9(1):194. doi: 10.1186/s13019-014-0194-5.
Several studies have implied that the time of radiation exposure for patients and operators during the transradial approach for coronary angiography (TRA) is associated with the use of different guidewire or catheter and operator's finesse. This study aimed to assess the effects of non-hydrophilic or hydrophilic guidewire and operator expertise on fluoroscopy time and procedure time of TRA and further effects on the procedure safety.
A total of 1035 consecutive patients undergoing TRA were recruited prospectively and respectively divided into non-hydrophilic guidewire and hydrophilic guidewire group, or well-experienced group and less-experienced group. The primary endpoints were fluoroscopy time and procedure time. Secondary endpoints included contrast volume, cost, guidewire exchange, switchover and complications .
TRA by non-hydrophilic guidewire group showed shorter fluoroscopy time and procedure time compared with hydrophilic guidewire group, similar results were found between well-experienced group and less-experienced group. Moreover, using of non-hydrophilic guidewire significantly reduced the incidence of hematoma and abnormal guidewie advancement, well-experienced group showed less dosage of contrast volume, lower incidence of radial artery spasm and frequency of guidewire exchange.
TRA by non-hydrophilic guidewire and well-experienced operator can decrease radiation exposure of patients and operators through reducing the fluoroscopy time and procedure time and further increase procedure safety. These will contribute to the optimization of TRA procedure and promote its widely application.
多项研究表明，在经桡动脉途径行冠状动脉造影术（TRA）期间，患者和术者的辐射暴露时间与使用不同的导丝或导管以及术者的操作技巧有关。本研究旨在评估非亲水或亲水导丝以及术者经验对TRA透视时间和手术时间的影响，以及对手术安全性的进一步影响。
前瞻性招募了1035例连续接受TRA的患者，分别分为非亲水导丝组和亲水导丝组，或经验丰富组和经验较少组。主要终点为透视时间和手术时间。次要终点包括造影剂用量、费用、导丝更换、转换和并发症。
与亲水导丝组相比，非亲水导丝组的TRA透视时间和手术时间更短，经验丰富组和经验较少组之间也发现了类似结果。此外，使用非亲水导丝显著降低了血肿和导丝异常推进的发生率，经验丰富组的造影剂用量更少，桡动脉痉挛的发生率更低，导丝更换频率更低。
非亲水导丝和经验丰富的术者进行TRA可通过缩短透视时间和手术时间来减少患者和术者的辐射暴露，并进一步提高手术安全性。这些将有助于优化TRA手术并促进其广泛应用。
