Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Catheter Cardiovasc Interv. 2021 May 1;97 Suppl 2:1063-1071. doi: 10.1002/ccd.29653. Epub 2021 Mar 22.
We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients.
RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk.
We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI.
7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p < .001). No parameters significantly differed between patients with and without RAO. TRI history was the only independent risk factor of early RAO (odds ratio: 6.047, 95% confidence interval: 1.100-33.253, p = .039).
7-Fr sheath use after transradial access for complex PCI is feasible and safe. Evaluating the radial artery within 24 hr after TRI allows timely RAO recognition, important for taking measures to maintain radial artery patency and preserve access for future TRIs.
本研究旨在探讨在中国患者经桡动脉冠状动脉介入治疗（TRI）中，使用 7Fr 鞘管对早期桡动脉闭塞（RAO）发生率的影响。
RAO 会妨碍血管通路对未来的使用。TRI 通常通过 5Fr 或 6Fr 导管进行；使用 7Fr 鞘管可进行复杂的冠状动脉介入治疗，但可能会增加 RAO 风险。
我们前瞻性纳入了 130 例连续接受复杂 TRI 并使用 7Fr 鞘管的患者。在 TRI 前后进行桡动脉超声评估。将 TRI 后 6-24 小时内超声未见血流定义为早期 RAO。采用多变量 logistic 回归确定与 TRI 后早期 RAO 相关的因素。
7Fr 鞘管主要用于慢性完全闭塞（44.6%）、分叉病变（30.0%）和迂曲钙化病变（25.4%）。所有患者均成功置鞘。经皮冠状动脉介入治疗（PCI）成功率为 96.2%；119 例（91.5%）患者 TRI 后桡动脉通畅。所有 11 例 RAO 患者（8.5%）均无症状。术后桡动脉直径明显增大（3.1±0.4mm），术前为（2.6±0.5mm）（p<.001）。RAO 组与无 RAO 组患者各参数均无显著差异。TRI 史是早期 RAO 的唯一独立危险因素（优势比：6.047，95%置信区间：1.100-33.253，p=0.039）。
经桡动脉入路行复杂 PCI 后使用 7Fr 鞘管是可行且安全的。在 TRI 后 24 小时内评估桡动脉可及时发现 RAO，这对于采取措施维持桡动脉通畅和保留未来 TRI 的血管通路非常重要。
