West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany.
Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany.
Vasa. 2020 Oct;49(6):463-466. doi: 10.1024/0301-1526/a000892. Epub 2020 Jul 16.
: The transradial artery approach is the preferred access for cardiac catheterization according to current guidelines. However, the most common complication is radial artery occlusion (RAO). Despite the rare indication for surgical reopening, the occluded radial artery is not available for further procedures or as a potential bypass graft. Still, treatment regimens for RAO are scarce. We now determined whether the addition of antithrombotic to antiplatelet therapy improves the rate of partial or complete regain of patency in RAO following transradial cardiac catheterization in a retrospective analysis. : In a two-center tertiary referral hospital retrospective analysis 4135 files of patients who had undergone transradial catheterization were screened for documented RAO. 141 patients were identified and 138 patients with complete information on the medical regimen and ultrasound examinations for a maximum of 3 months were included in the analysis, whereas 3 patients were excluded due to missing or incomplete follow-up information. : 3.3% of all patients that had undergone transradial catheterization featured an oligosymptomatic RAO, confirmed by color-coded duplex sonography. 21% of patients with additional anticoagulation regained full patency vs. 9% without additional anticoagulation (p = 0.07). 40% of patients with anticoagulation featured a partial or full regain of patency vs. 16% of patients without additional anticoagulation for a maximum of 3 months treatment (p = 0.006). No major bleedings were reported during the follow-up visits. : RAO remains a rare complication of cardiac catheterization. The addition of antithrombotic therapy for 3 months appears to safely improve the partial or even full regain of radial patency in case of postinterventional RAO.
经桡动脉入路是目前指南推荐的心脏导管插入术的首选入路。然而，最常见的并发症是桡动脉闭塞（RAO）。尽管很少有需要手术再通的指征，但闭塞的桡动脉不能用于进一步的操作或作为潜在的旁路移植。尽管如此，RAO 的治疗方案仍然很少。我们现在确定在经桡动脉心脏导管插入术后，抗栓治疗联合抗血小板治疗是否能提高 RAO 患者桡动脉部分或完全再通的比率。
在一项回顾性分析中，我们对在两家三级转诊医院接受经桡动脉导管插入术的 4135 例患者的档案进行了筛选，以确定有记录的 RAO。确定了 141 例患者，其中 138 例患者有完整的药物治疗方案和最多 3 个月的超声检查信息，纳入了分析，而 3 例患者由于随访信息缺失或不完整而被排除。
所有接受经桡动脉导管插入术的患者中，有 3.3%的患者出现了症状性桡动脉闭塞，彩色双功能超声证实了这一点。接受额外抗凝治疗的患者中，21%的患者完全再通，而未接受额外抗凝治疗的患者中只有 9%（p=0.07）。接受抗凝治疗的患者中，40%的患者出现了部分或完全再通，而未接受额外抗凝治疗的患者中只有 16%在最长 3 个月的治疗期间出现了部分或完全再通（p=0.006）。在随访期间没有报告大出血。
RAO 仍然是心脏导管插入术的罕见并发症。在介入后 RAO 的情况下，联合应用抗栓治疗 3 个月似乎可以安全地提高桡动脉部分或甚至完全再通的可能性。
