Koutouzis Michael, Kontopodis Eleftherios, Tassopoulos Andreas, Tsiafoutis Ioannis, Katsanou Konstantina, Rigatou Aggeliki, Didagelos Matthaios, Andreou Konstantinos, Lazaris Efstathios, Oikonomidis Nikolaos, Maniotis Christos, Ziakas Antonios
Department of Cardiology, Red Cross General Hospital, Greece.
Department of Cardiology, Red Cross General Hospital, Greece.
Cardiovasc Revasc Med. 2019 Aug;20(8):678-680. doi: 10.1016/j.carrev.2018.09.018. Epub 2018 Oct 2.
The aim of this study was to evaluate the efficacy and safety of distal radial (DR) versus traditional radial (TR) approach during coronary angiography.
Two hundred patients scheduled to undergo transradial coronary angiography were randomized between the two approaches. Primary endpoint of the study was switching to another access site due to inability of successful target artery cannulation. Secondary endpoints were time to cannulation, total procedure duration, number of attempts, number of skin punctures and duration of manual hemostasis. Secondary safety endpoints were the rate of moderate or severe spasm, arm hematoma EASY class III or more and radial artery occlusion at discharge. Quality of life endpoint was the patient's preference of cannulation method at 30 days.
The primary endpoint was met in 30 patients (30%) from the DR group and 2 patients (2%) from the TR group (p < 0.001). The time of cannulation was longer in the DR group compared to the TR group (269 ± 251 s vs 140 ± 161 s, p < 0.001), but this did not affect the total procedural duration (925 ± 896 s vs 831 ± 424 s, p = 0.494). The number of attempts and the number of skin punctures were more in the DR group compared to the TR group (6.8 ± 6.2 vs 3.4 ± 4.5, p < 0.001 and 2.4 ± 1.7 vs 1.6 ± 1.2, p < 0.001, respectively). However, DR treated patients had faster manual hemostasis time compared to TR treated patients (568 ± 462 s vs 841 ± 574 s, p = 0.002). There were no differences recorded in the safety endpoints of moderate or severe spasm, EASY grade III or more radial hematomas or the incidence of radial artery occlusion after the procedure. Patients' preference to the randomized puncture sites was the same (79% vs 85%, p = 0.358).
Distal radial approach is associated with lower successful cannulation rates and shorter manual hemostasis time compared to the traditional radial approach.
本研究旨在评估冠状动脉造影术中桡动脉远心端（DR）入路与传统桡动脉（TR）入路的有效性和安全性。
200例计划接受经桡动脉冠状动脉造影的患者被随机分配至两种入路组。本研究的主要终点是因无法成功穿刺目标动脉而转换至另一穿刺部位。次要终点包括穿刺时间、总手术时长、尝试次数、皮肤穿刺次数和手动压迫止血时长。次要安全终点是中度或重度痉挛发生率、手臂血肿EASY分级III级及以上以及出院时桡动脉闭塞情况。生活质量终点是患者在30天时对穿刺方法的偏好。
DR组30例患者（30%）和TR组2例患者（2%）达到主要终点（p < 0.001）。与TR组相比，DR组的穿刺时间更长（269 ± 251秒 vs 140 ± 161秒，p < 0.001），但这并未影响总手术时长（925 ± 896秒 vs 831 ± 424秒，p = 0.494）。与TR组相比，DR组的尝试次数和皮肤穿刺次数更多（分别为6.8 ± 6.2次 vs 3.4 ± 4.5次，p < 0.001；2.4 ± 1.7次 vs 1.6 ± 1.2次，p < 0.
