Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, the Netherlands; Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
Cardiovasc Revasc Med. 2022 Jan;34:134-139. doi: 10.1016/j.carrev.2021.01.014. Epub 2021 Jan 16.
International coronary revascularization guidelines recommend both, transradial vascular access for coronary angiography/intervention and use of the radial artery as a conduit for coronary artery bypass grafting (CABG). These recommendations may pose a clinical dilemma, as transradial access exposes these arteries to vascular trauma which makes them potentially unsuitable as future grafts. In this study, we investigated the awareness and views of cardiologists on these guideline recommendations.
We performed semi-structured interviews with 50 cardiologists from 19 centers, who regularly perform coronary angiographies or interventions, and outlined clinical scenarios to evaluate their preference of vascular access. In addition, we assessed whether preference was related to sub-specialization.
The interviewed cardiologists had 16 ± 9.3 years of professional experience. There were 23 (46%) cardiologists from 7 centers without percutaneous coronary intervention facilities, and 27 (56%) cardiologists from 12 interventional centers. All 50 (100%) cardiologists indicated familiarity with the guidelines, yet 28 (56%) said not to be familiar with the aforementioned dilemma, and 9 (18%) stated there was no dilemma at all. Responses did not differ significantly between interventional (n = 28) and non-interventional (n = 22) cardiologists; however, if the right radial artery was unavailable (e.g., occluded), interventional cardiologists more often said to prefer access via the left radial artery (18/28 (64%) vs. 5/22 (23%), p = 0.001).
More than half of the interviewed cardiologists indicated that they had not realized that left transradial access preceding CABG may preclude later use of this artery as a conduit. Notably, in case of unavailability of the right radial artery, interventional cardiologists preferred left transradial access more often than non-interventional cardiologists.
国际冠状动脉血运重建指南建议，经桡动脉进行冠状动脉造影/介入治疗，以及将桡动脉作为冠状动脉旁路移植术（CABG）的移植物。这些建议可能会带来临床困境，因为经桡动脉入路会使这些动脉受到血管创伤，从而使其可能不适合作为未来的移植物。在这项研究中，我们调查了心脏病专家对这些指南建议的认识和看法。
我们对 19 个中心的 50 名经常进行冠状动脉造影或介入治疗的心脏病专家进行了半结构化访谈，并概述了临床情况，以评估他们对血管入路的偏好。此外，我们还评估了这种偏好是否与亚专业有关。
接受访谈的心脏病专家有 16±9.3 年的专业经验。有 23 名（46%）心脏病专家来自 7 个没有经皮冠状动脉介入治疗设施的中心，27 名（56%）心脏病专家来自 12 个介入治疗中心。所有 50 名（100%）心脏病专家都表示熟悉指南，但 28 名（56%）表示不熟悉上述困境，9 名（18%）表示根本没有困境。介入心脏病专家和非介入心脏病专家的回答没有显著差异；然而，如果右侧桡动脉不可用（例如闭塞），介入心脏病专家更倾向于选择左侧桡动脉入路（18/28 [64%] 比 5/22 [23%]，p=0.001）。
超过一半的接受访谈的心脏病专家表示，他们没有意识到，在 CABG 之前经左侧桡动脉入路可能会使这条动脉以后无法作为移植物使用。值得注意的是，如果右侧桡动脉不可用，介入心脏病专家比非介入心脏病专家更倾向于选择左侧经桡动脉入路。
