Yin Wei-Hsian, Tseng Chin-Kun, Tsao Tien-Ping, Jen Hsu-Lung, Huang Wen-Pin, Huang Chien-Lung, Wang Jiann-Jong, Young Mason Shing
Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China ; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, China ; Cardiovascular Research Centre, School of Medicine, National Yang-Ming University, Taipei, Taiwan, China.
Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
J Geriatr Cardiol. 2015 Sep;12(5):489-96. doi: 10.11909/j.issn.1671-5411.2015.05.004.
Although radial access for drug-eluting stent (DES) combined with rotational atherectomy (RA) in patients with calcified coronary lesions may be associated with a lower risk of major bleeding complications and obtain favorable clinical results compared with femoral access, the long-term outcome data of this approach were limited in contemporary DES era.
METHODS & RESULTS: This retrospective study sought to compare in-hospital and long-term outcomes for patients undergoing RA via the transradial (TR) and transfemoral (TF) route in 126 consecutive patients (59 radial, 67 femoral) from 2009 to 2014. TR RA procedures were performed in 44/62 (71%) by the three TR operators, compared with 15/64 (23%) by the four TF operators in the present study. Significantly smaller diameter guide catheters and burrs (1.39 ± 0.16 mm vs. 1.53 ± 0.24 mm, P = 0.001) were used in the TR group. Procedural success rates were similar in both TR and TF groups. There was a significantly less major access site bleeding complications in favor of radial artery access (2% vs. 16%, P = 0.012). The incidence of in-hospital death or myocardial infarction was low in both groups. Although a trend of lower adverse event rate was demonstrated in the TR group compared with the TF one, no statistical significance (21% vs. 27%, P = 0.135) was detected.
Radial access, a useful alternative to femoral access for RA and DES, can be safely and successfully performed on up to 71% of the patients with heavily calcified coronary lesions needing RA by experienced TR operators.
尽管在钙化冠状动脉病变患者中，经桡动脉途径进行药物洗脱支架（DES）联合旋磨术（RA）与经股动脉途径相比，可能与较低的大出血并发症风险相关，并能获得良好的临床结果，但在当代DES时代，这种方法的长期结局数据有限。
这项回顾性研究旨在比较2009年至2014年期间126例连续患者（59例经桡动脉，67例经股动脉）经桡动脉（TR）和经股动脉（TF）途径行RA的住院及长期结局。在本研究中，三位TR操作者对44/62例（71%）患者进行了TR RA手术，而四位TF操作者对15/64例（23%）患者进行了该手术。TR组使用的导引导管和磨头直径明显更小（1.39±0.16mm对1.53±0.24mm，P = 0.001）。TR组和TF组的手术成功率相似。经桡动脉途径的主要穿刺部位出血并发症明显更少（2%对16%，P = 0.012）。两组的住院死亡或心肌梗死发生率均较低。尽管与TF组相比，TR组不良事件发生率有降低趋势，但未检测到统计学意义（21%对27%，P = 0.135）。
对于需要行RA的重度钙化冠状动脉病变患者，经桡动脉途径是经股动脉途径的一种有用替代方法，经验丰富的TR操作者对高达71%的此类患者可安全、成功地进行该操作。
