Ying Lianghong, Xu Ke, Gong Xiaoxuan, Liu Xiaoyan, Fan Yuansheng, Zhao Haiping, Wang Fei, Khurwolah Mohammad Reeaze, Li Chunjian
Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, China.
Cardiol J. 2018;25(1):1-6. doi: 10.5603/CJ.a2017.0125. Epub 2017 Oct 24.
Puncture-induced radial artery spasm (RAS) may extend the duration of coronary an-giography (CAG) or cause transradial access failure. Flow-mediated dilatation (FMD), a widely-used noninvasive approach for assessing endothelial function, was reported to remove the entrapped radial sheath after percutaneous coronary intervention. Herein, the efficacy and safety of FMD in treating puncture-induced RAS before transradial CAG was investigated.
Ninety patients with puncture-induced RAS were randomized in a 1:1:1 ratio into three groups: FMD group was immediately treated with blockage of brachial artery blood for 5 min using a sphygmomanometric cuff and then rapid relief; nitroglycerin (NTG) group was administered with 0.5 mg sublingual NTG instantly; and the no-therapy group was treated with a wait-and-watch strategy. The time of radial pulse recovery, and regional and systemic complications were recorded.
The rate of radial pulse recovery within 30 min in FMD group was significantly higher than that in no-therapy group (97% vs. 73%, p = 0.026). The median time to return of radial pulse in FMD group and NTG group was significantly shorter than that in no-therapy group (7 [6.5-9] min vs. 15 [12-18] min, 8 [7-9] min vs. 15 [12-18] min, respectively; both p < 0.001). Headache and decreased blood pressure were more prevalent in NTG group than those in FMD and no-therapy groups.
FMD is a feasible, noninvasive and nonpharmacological approach to relieve RAS and facilitate radial artery cannulation after an initial failed attempt. (Cardiol J 2018; 25, 1: 1-6).
穿刺引起的桡动脉痉挛（RAS）可能会延长冠状动脉造影（CAG）的时间或导致经桡动脉途径失败。血流介导的血管舒张功能（FMD）是一种广泛用于评估内皮功能的非侵入性方法，据报道在经皮冠状动脉介入治疗后可移除被困的桡动脉鞘管。在此，研究了FMD在经桡动脉CAG前治疗穿刺引起的RAS的有效性和安全性。
90例穿刺引起RAS的患者按1:1:1比例随机分为三组：FMD组立即使用血压计袖带阻断肱动脉血流5分钟，然后迅速解除；硝酸甘油（NTG）组立即舌下含服0.5mg NTG；未治疗组采用观察等待策略。记录桡动脉搏动恢复时间以及局部和全身并发症。
FMD组30分钟内桡动脉搏动恢复率显著高于未治疗组（97%对73%，p = 0.026）。FMD组和NTG组桡动脉搏动恢复的中位时间显著短于未治疗组（分别为7[6.5 - 9]分钟对15[12 - 18]分钟，8[7 - 9]分钟对15[12 - 18]分钟；p均<0.001）。NTG组头痛和血压下降比FMD组和未治疗组更常见。
FMD是一种可行、非侵入性且非药物性的方法，可缓解RAS并在初次尝试失败后促进桡动脉插管。（《心脏病学杂志》2018年；25卷，第1期：1 - 6页）
