Roy Sumon, Choxi Ravi, Wasilewski Melissa, Jovin Ion S
Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.
Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):1133-1137. doi: 10.1002/ccd.29771. Epub 2021 May 14.
Transradial access of the vascular system for coronary angiography and percutaneous coronary intervention has become the primary approach in several cardiac catheterization laboratories across the world. The paradigm shift from transfemoral access has been driven by improved outcomes in patients undergoing these cardiac procedures by transradial access. Radial artery occlusion is the most common vascular complication of transradial coronary procedures. Only a few studies have reported on the optimal treatment of radial artery occlusion, with ulnar artery compression and anticoagulation, especially with low-molecular-weight heparin, having shown the best results. In this case series, four patients who were found to have evidence of post-cardiac catheterization radial artery occlusion on ultrasound imaging were treated with a 30-day course of apixaban. Three of the four patients showed complete resolution of radial artery occlusion with addition of apixaban to current standard therapeutic strategies. This case series shows that treatment with novel oral anticoagulants can be an alternative and more convenient option compared to subcutaneous injection of low-molecular heparin for anticoagulation in patients with post-coronary angiography radial artery occlusion.
经桡动脉途径进行冠状动脉造影和经皮冠状动脉介入治疗已成为全球多个心脏导管实验室的主要方法。从股动脉途径向经桡动脉途径的模式转变是由经桡动脉途径进行这些心脏手术的患者预后改善所推动的。桡动脉闭塞是经桡动脉冠状动脉手术最常见的血管并发症。仅有少数研究报道了桡动脉闭塞的最佳治疗方法，其中尺动脉压迫和抗凝，尤其是使用低分子量肝素，已显示出最佳效果。在本病例系列中，4例经超声成像发现有心脏导管术后桡动脉闭塞证据的患者接受了30天的阿哌沙班治疗。4例患者中有3例在当前标准治疗策略基础上加用阿哌沙班后桡动脉闭塞完全缓解。该病例系列表明，对于冠状动脉造影术后桡动脉闭塞患者，与皮下注射低分子肝素抗凝相比，使用新型口服抗凝药治疗可能是一种替代且更方便的选择。
