Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States of America.
Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, United States of America.
Cardiovasc Revasc Med. 2021 May;26:39-45. doi: 10.1016/j.carrev.2020.11.001. Epub 2020 Nov 4.
To compare the outcomes of transulnar access (TUA) versus transradial access (TRA) for coronary angiography (CA) and percutaneous coronary intervention (PCI).
TUA has emerged as an alternative access site in patients who fail TRA or not candidates for it. Data comparing both approaches have been limited.
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared outcomes of TUA versus TRA for CA and/or PCI.
Data from seven RCTs, with 5721 patients (TUA = 2874 and TRA = 2847), were analyzed. TUA, compared with TRA, was associated with a similar risk of major adverse cardiovascular and cerebrovascular events (MACCE) (3.05% vs. 3.32%, OR 0.9, 95% CI [0.65, 1.25]; P = 0.53), access cross-over rate (9.4% vs. 4.1%, OR 1.92, 95% CI [0.91, 4.06]; P = 0.09), access-site complications (12.7% vs. 13%, OR 0.97, 95% CI [0.79, 1.19]; P = 0.75), vasospasm (8.1% vs. 9%, OR 0.83, 95% CI [0.54, 1.27]; P = 0.38), procedural time (MD 1.34 min, 95% CI [-1.31, 3.99]; P = 0.32) and fluoroscopy time (MD 0.29 min, 95% CI [-0.33, 0.91]; P = 0.36). Additional analysis of patients who underwent PCI showed no difference in the incidence of MACCE, access-site complications and large hematoma. The risk of local bleeding was lower in the TUA group compared with TRA (4.9% vs. 8.5%, OR 0.55, 95% CI [0.33, 0.93]; P = 0.02).
TUA is a safe approach in both CA and PCI with comparable outcomes to TRA. PCI with TUA might be associated with a lower risk of local bleeding compared with TRA.
比较经桡动脉（TRA）与经尺动脉（TUA）入路行冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）的结果。
TUA 已成为 TRA 失败或不适合 TRA 患者的另一种入路选择。比较这两种方法的相关数据有限。
我们对比较 TUA 与 TRA 行 CA 和/或 PCI 的随机对照试验（RCT）进行了系统评价和荟萃分析。
纳入了 7 项 RCT，共 5721 例患者（TUA 组 2874 例，TRA 组 2847 例）。结果显示，与 TRA 相比，TUA 行 MACCE（3.05% vs. 3.32%，OR 0.9，95%CI [0.65, 1.25]；P=0.53）、交叉入路率（9.4% vs. 4.1%，OR 1.92，95%CI [0.91, 4.06]；P=0.09）、血管并发症（12.7% vs. 13%，OR 0.97，95%CI [0.79, 1.19]；P=0.75）、血管痉挛（8.1% vs. 9%，OR 0.83，95%CI [0.54, 1.27]；P=0.38）、手术时间（MD 1.34min，95%CI [-1.31, 3.99]；P=0.32）和透视时间（MD 0.29min，95%CI [-0.33, 0.91]；P=0.36）相似。对行 PCI 的患者进行的进一步分析显示，MACCE、血管并发症和大血肿的发生率无差异。与 TRA 相比，TUA 组局部出血的风险较低（4.9% vs. 8.5%，OR 0.55，95%CI [0.33, 0.93]；P=0.02）。
TUA 是 CA 和 PCI 安全的入路，与 TRA 相比结果相当。与 TRA 相比，TUA 行 PCI 可能与局部出血风险较低相关。
