抗凝和血管活性药物对导管介入治疗后桡动脉再通的影响：一项病例对照研究。
Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case-control study.
机构信息
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
出版信息
Eur J Med Res. 2018 May 22;23(1):25. doi: 10.1186/s40001-018-0324-y.
BACKGROUND
Radial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail.
AIM
The objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization.
PATIENTS AND METHODS
Overall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination.
RESULTS
Eight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229).
CONCLUSION
RAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.
背景
与股动脉入路相比，桡动脉入路具有更高的安全性，是冠状动脉介入治疗的主要入路。桡动脉闭塞（RAO）是经桡动脉导管插入术的主要并发症，可导致严重症状和永久性动脉闭塞。经桡动脉入路后 RAO 的发生率为 5%至 38%，关于治疗的数据很少。抗凝和血管活性药物是否能在经导管插入术后恢复桡动脉通畅（RAP）方面提供额外的益处尚未得到详细研究。
目的
本研究旨在探讨抗凝和血管活性药物对经桡动脉导管插入术后确诊 RAO 后恢复 RAP 的影响。
患者和方法
共筛选了 2635 例患者。2215 例（84%）经股动脉进行导管插入术，420 例（16%）经桡动脉进行导管插入术。30 例患者出现 RAO。在 RAO 的情况下，患者被分为三组：抗凝组、抗凝加前列地尔组和对照组。在 3 个月后通过超声和临床检查进行随访。
结果
8 例患者接受抗凝治疗，11 例患者接受抗凝加前列地尔治疗。11 例患者作为对照组。与对照组（0%，p=0.006）相比，导管插入术后 RAP 恢复率在接受治疗的患者中更高（79.5%）。亚组分析显示，接受抗凝治疗的患者 RAP 恢复率更高（62.5%），而对照组（0%，p=0.002）。与抗凝治疗（62.5%）相比，联合应用前列地尔治疗对恢复 RAP 没有影响（33.3%，p=0.229）。
结论
RAO 应采用抗凝治疗以恢复通畅。血管活性药物的加入并没有带来进一步的有益效果。需要进一步研究 RAO 后的预防和治疗策略。
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