Cardiology department, Hedi Chaker Hospital , Sfax, Tunisia.
Research Unit UR17ES37, University of Medicine, Sfax University , Tunisia.
Libyan J Med. 2021 Dec;16(1):1830600. doi: 10.1080/19932820.2020.1830600.
The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p < 0.0008). Successful catheterization was achieved in 98% for the CRA group and in 88% for the DRA group (p = 0.008). Radial artery occlusion, detected by ultrasonography, was found in 3 patients in the CRA group (3.1%) and nobody in the DRA group (p = 0.25). The median diameter of the radial artery diameter was higher in the DRA than the CRA group (2.2 mm vs 2.1 mm; p = 0.007). The distal radial approach is feasible and safe for coronary angiography and interventions, but needs a learning curve.
桡动脉远端入路（DRA）在局部并发症和患者及术者舒适度方面优于传统桡动脉入路（CRA）。因此，我们旨在比较 DRA 和 CRA 在真实人群中的可行性和安全性。我们进行了一项前瞻性、观察性的多中心试验，纳入了 2019 年 9 月所有行冠状动脉介入治疗的患者。排除近端或远端桡动脉脉搏不可触及的患者。因此，入路的选择由术者决定。主要终点是穿刺失败和手术失败。次要终点是穿刺时间、术后 1 天通过多普勒评估的局部并发症和桡动脉闭塞。我们纳入了 177 名患者，分为两组：CRA 组（n=95）和 DRA 组（n=82）。CRA 组中经皮介入治疗成功率为 37%，DRA 组为 34%（p=0.7）。两组穿刺时间无显著差异（p=0.16）。DRA 组穿刺失败率明显较高（4.8%比 2%，p<0.0008）。CRA 组 98%的患者成功置管，DRA 组 88%的患者成功置管（p=0.008）。CRA 组有 3 例（3.1%）患者经超声检查发现桡动脉闭塞，DRA 组无患者（p=0.25）。DRA 组桡动脉直径中位数高于 CRA 组（2.2mm 比 2.1mm；p=0.007）。桡动脉远端入路行冠状动脉造影和介入治疗是可行且安全的，但需要一定的学习曲线。
