Division of Cardiology, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy -
Division of Cardiology, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
Minerva Cardiol Angiol. 2022 Apr;70(2):129-137. doi: 10.23736/S2724-5683.21.05483-9. Epub 2021 Mar 11.
Distal transradial access (dTRA) has been recently proposed as an innovative access for coronary procedures and a valuable alternative to conventional transradial access (cTRA). The aim of this study was to assess the safety of dTRA versus cTRA in patients undergoing percutaneous coronary angiography and intervention.
In this single-center randomized trial, consecutive patients admitted for stable cardiac condition or acute coronary syndrome (ACS) were assigned to dTRA or cTRA. The primary endpoint was an early discharge after transradial stenting of coronary arteries (EASY) grade ≥II access-site hematoma (ASH). Vascular access failure, radial artery occlusion (RAO) at hospital discharge, 30-day rates of death, myocardial infarction, stroke and bleeding not related to coronary artery bypass grafting were considered as secondary endpoints.
A total of 204 patients were included and randomized to dTRA (N.=100) or cTRA (N.=104). The two populations were similar, except for a higher percentage of ACS in the dTRA than in the cTRA group (38% versus 24%, P=0.022). The rate of EASY grade ≥II ASH was lower in dTRA than in cTRA patients, but the difference was not statistically significant (4% versus 8.4%, respectively, P=0.25). Vascular access failure was more frequent in dTRA patients than in cTRA patients (34% versus 8.7%, P<0.0001). We detected no case of RAO at hospital discharge and similar rates of 30-day adverse events in both groups.
DTRA is safe and feasible. When compared to cTRA, dTRA is technically more demanding and limited by more frequent crossover to an alternative vascular access.
远端经桡动脉入路（dTRA）最近被提议作为冠状动脉介入治疗的一种创新入路，是传统经桡动脉入路（cTRA）的有价值的替代方法。本研究旨在评估接受经皮冠状动脉造影和介入治疗的患者中 dTRA 与 cTRA 的安全性。
在这项单中心随机试验中，连续收治的稳定型心脏疾病或急性冠状动脉综合征（ACS）患者被分配至 dTRA 或 cTRA 组。主要终点是经桡动脉支架置入冠状动脉（EASY）分级≥Ⅱ级的经桡动脉入路部位血肿（ASH）的早期出院（EASY）。血管入路失败、出院时桡动脉闭塞（RAO）、30 天死亡率、心肌梗死、卒中和与冠状动脉旁路移植术无关的出血被视为次要终点。
共纳入 204 例患者并随机分为 dTRA 组（n=100）或 cTRA 组（n=104）。两组人群相似，除 dTRA 组 ACS 比例高于 cTRA 组（38% vs. 24%，P=0.022）外。dTRA 组的 EASY 分级≥Ⅱ级 ASH 发生率低于 cTRA 组，但差异无统计学意义（分别为 4%和 8.4%，P=0.25）。dTRA 组血管入路失败的发生率高于 cTRA 组（34% vs. 8.7%，P<0.0001）。我们未发现出院时 RAO 的病例，两组 30 天不良事件的发生率相似。
dTRA 是安全可行的。与 cTRA 相比，dTRA 技术上要求更高，并且由于更频繁地转为替代血管入路，受到限制。
