桡动脉远端入路作为冠状动脉造影和介入治疗的默认方法。
Distal transradial access as default approach for coronary angiography and interventions.
作者信息
Oliveira Marcos Danillo Peixoto, Navarro Ednelson Cunha, Kiemeneij Ferdinand
机构信息
Department of Interventional Cardiology, Hospital Regional do Vale do Paraíba, Taubaté, São Paulo, Brazil.
Interventional Cardiologist, the Netherlands.
出版信息
Cardiovasc Diagn Ther. 2019 Oct;9(5):513-519. doi: 10.21037/cdt.2019.09.06.
BACKGROUND
Distal transradial access (dTRA) as a refinement of the conventional transradial access has advantages in terms of patient and operator comfort and risk of radial artery (RA) occlusion. RA preservation with this new technique could be a relevant issue in patients requiring its future use. In turn, one relevant drawback is the more challenging puncture of a smaller artery. In order to evaluate the real world feasibility and safety of both right (rdTRA) and left (ldTRA) distal transradial access as default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI), this prospective observational registry was conducted.
METHODS
From February to July 2019, 435 consecutive patients underwent CAG and/or PCI (620 procedures at all, by two experienced transradial operators) through rdTRA or ldTRA.
RESULTS
Mean patient age was 62.4 years old. Most were male (66.0%). The majority (49.4%) of patients had an acute coronary syndrome; overall, 15.2% with ST-elevation acute myocardial infarction (STEMI). Distal RA was successfully punctured in all patients, always without ultrasound guidance, with puncture and sheath insertion at until 2 attempts in the vast majority of patients. We had only 3.0% access site crossovers (successful arterial puncture but failed sheath insertion), mainly performed via the contralateral dTRA (53.8%). Successful dTRA sheath insertion was then achieved in 98.6% of all 435 patients. Redo ipsilateral dTRA was performed in 2.5% of patients. Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications were recorded.
CONCLUSIONS
dTRA as default approach for routine CAG and/or PCI by experienced transradial operators appears to be safe and feasible. Further randomized and larger trials are still needed to assure the clinical benefits and the safety of this new technique.
背景
作为传统经桡动脉途径的改进方法，远端经桡动脉穿刺（dTRA）在患者舒适度、术者操作便利性以及桡动脉（RA）闭塞风险方面具有优势。对于未来可能需要使用桡动脉的患者而言，采用这种新技术保留桡动脉可能是一个重要问题。反过来，一个相关的缺点是穿刺较细动脉更具挑战性。为了评估右（rdTRA）、左（ldTRA）侧远端经桡动脉穿刺作为常规冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）默认穿刺部位在现实世界中的可行性和安全性，开展了这项前瞻性观察性注册研究。
方法
2019年2月至7月，435例连续患者接受了通过rdTRA或ldTRA进行的CAG和/或PCI（共620例手术，由两名经验丰富的经桡动脉术者操作）。
结果
患者平均年龄为62.4岁。大多数为男性（66.0%）。大多数患者（49.4%）患有急性冠状动脉综合征；总体而言，15.2%为ST段抬高型急性心肌梗死（STEMI）。所有患者的远端桡动脉均成功穿刺，且均未使用超声引导，绝大多数患者在2次尝试内完成穿刺和鞘管置入。我们仅有3.0%的穿刺部位交叉情况（动脉穿刺成功但鞘管置入失败），主要通过对侧dTRA进行（53.8%）。然后，435例患者中98.6%成功置入dTRA鞘管。2.5%的患者进行了同侧dTRA再次穿刺。所有患者出院时远端和近端桡动脉搏动均可触及。未记录到重大心脑血管不良事件和重大并发症。
结论
对于经验丰富的经桡动脉术者而言，dTRA作为常规CAG和/或PCI的默认方法似乎是安全可行的。仍需要进一步的随机、更大规模试验来确保这项新技术的临床益处和安全性。
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