Cardiology, Isala Hospitals, Zwolle, The Netherlands.
Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Wallonie, Belgium.
BMJ Open. 2020 Jul 20;10(7):e038042. doi: 10.1136/bmjopen-2020-038042.
The radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.
A total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.
Ethical approval for the study was granted by the local Ethics Committee at each recruiting center ('Medisch Ethische Toetsing Commissie Isala Zwolle', 'Commissie voor medische ethiek ZNA', 'Comité Medische Ethiek Ziekenhuis Oost-Limburg', 'Comité d'éthique CHU-Charleroi-ISPPC', 'Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve', 'Ethik Kommission de Ärztekammer Nordrhein' and 'Riverside Research Ethics Committee'). The trial outcomes will be published in peer-reviewed journals of the concerned literature.
NCT03846752.
由于桡动脉入路相关出血并发症较少,桡动脉已成为稳定型冠状动脉疾病和急性冠状动脉综合征患者经皮冠状动脉介入治疗(PCI)的标准入路。在比较桡动脉与股动脉入路的安全性和疗效的随机试验中,复杂冠状动脉病变患者的代表性不足。股动脉目前是复杂冠状动脉病变患者最常应用的入路,尤其是需要大口径引导导管时。随着技术的进步,当需要大口径引导导管时,经桡动脉 PCI 可能越来越多地应用于复杂冠状动脉病变患者,并且与经股动脉入路相比可能是一种更安全的替代方法。
总共将 388 名接受复杂 PCI 的患者随机分为桡动脉 7Fr 入路(使用 Terumo Glidesheath Slender[Terumo,日本])或股动脉 7Fr 入路作为对照。主要终点是临床相关的桡动脉相关出血和/或需要介入治疗的血管并发症的复合终点发生率。两组之间还将比较手术成功率和 1 个月内的主要不良心血管事件。
该研究的伦理批准已获得每个招募中心的当地伦理委员会的批准(“Isala Zwolle 医学伦理审查委员会”、“ZNA 医学伦理委员会”、“Ziekenhuis Oost-Limburg 医学伦理委员会”、“Charleroi-ISPPC 天主教大学伦理委员会”、“日内瓦州和日内瓦市医学伦理委员会”、“北莱茵医学伦理委员会”和“Riverside Research Ethics Committee”)。试验结果将发表在相关文献的同行评议期刊上。
NCT03846752。