Liu Z J, Niu D, Li Z X, Guo J C
Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Jan 11;49(1):37-42. doi: 10.3760/cma.j.cn112148-20200312-00196.
To observe the radial artery thrombosis (RAT) during transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by optical coherence tomography (OCT), and to investigate the risk factors of RAT during the CAG and/or PCI. In this retrospective study, we consecutively reviewed the radial artery OCT examination results of the patients who underwent OCT guided transradial CAG and/or PCI for acute coronary syndrome in heart center of Beijing Luhe hospital, Capital Medical University from October 2017 to July 2018. The incidence of RAT was observed. The patients were divided into the RAT group and non-RAT group, clinical data were collected and compared. Moreover, the types and distributions of thrombus in radial artery as well as the acute radial artery injuries under OCT were observed. Univariate analysis followed by multivariate analysis were performed to identify potential risk factors. The radial artery patency and ischemic symptoms of the involved limb were followed up at the 24-hour and the 1-month after procedure. A total of 107 patients were included, the age was (58.1±12.5), and 78.5% were male (=84). The incidence of RAT was 26.2% (=28, 95% 17.9%-34.5%), and the main type of thrombus was white thrombus (=15, 53.6%). The commonest position of RAT was the proximal portion of radial artery (=17, 60.7%). The median thrombus volume was 0.05(0.03, 0.38) mm, and the median thrombus score was 6.5 (3.3, 13.8). In univariate analysis, the frequency of acute radial artery injury and use of bivalirudin were significantly higher and the procedure time was significantly longer in RAT group than those in non-RAT group (all <0.05). Multivariate regression analysis showed that the radial artery acute injury (5.82, 95% 2.09-16.20, =0.001) and the procedure time (1.04, 95% 1.01-1.06, =0.006) were independent risk factors of RAT. Rate of radial artery occlusion at 24 hours follow-up was similar between RAT and non-RAT group (7.14%(2/28), vs. 10.13%(8/79), =1.000). None of the patients complicated severe ischemic symptom of the operative limb. RAT is a high frequency access complication during transradial coronary intervention. This phenomenon can be accurately observed by OCT. Acute radial artery injury and prolonged procedure time are risk factors of RAT during transradial coronary intervention.
通过光学相干断层扫描（OCT）观察经桡动脉冠状动脉造影（CAG）和/或经皮冠状动脉介入治疗（PCI）过程中的桡动脉血栓形成（RAT），并探讨CAG和/或PCI过程中RAT的危险因素。在这项回顾性研究中，我们连续回顾了2017年10月至2018年7月在首都医科大学附属北京潞河医院心脏中心接受OCT引导下经桡动脉CAG和/或PCI治疗急性冠状动脉综合征患者的桡动脉OCT检查结果。观察RAT的发生率。将患者分为RAT组和非RAT组，收集并比较临床资料。此外，观察OCT下桡动脉血栓的类型和分布以及急性桡动脉损伤情况。进行单因素分析，然后进行多因素分析以确定潜在危险因素。术后24小时和1个月对受累肢体的桡动脉通畅情况和缺血症状进行随访。共纳入107例患者，年龄为（58.1±12.5）岁，男性占78.5%（=84例）。RAT的发生率为26.2%（=28例，95%可信区间为17.9%-34.5%），血栓主要类型为白色血栓（=15例，53.6%）。RAT最常见的部位是桡动脉近端（=17例，60.7%）。血栓体积中位数为0.05（0.03，0.38）mm，血栓评分中位数为6.5（3.3，13.8）。单因素分析显示，RAT组急性桡动脉损伤的发生率和比伐卢定的使用频率显著高于非RAT组，手术时间显著长于非RAT组（均P<0.05）。多因素回归分析显示，桡动脉急性损伤（5.82，95%可信区间为2.09-16.20，P=0.001）和手术时间（1.04，95%可信区间为1.01-1.06，P=0.006）是RAT的独立危险因素。RAT组和非RAT组术后24小时桡动脉闭塞率相似（7.14%（2/28）对10.13%（8/79），P=1.000）。所有患者均未出现手术肢体严重缺血症状。RAT是经桡动脉冠状动脉介入治疗中一种高频的血管入路并发症。这种现象可通过OCT准确观察到。急性桡动脉损伤和手术时间延长是经桡动脉冠状动脉介入治疗中RAT的危险因素。
