Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
Int J Cardiol. 2021 Dec 1;344:47-53. doi: 10.1016/j.ijcard.2021.10.003. Epub 2021 Oct 6.
Distal transradial artery access (DTRA) has recently gained attention due to potential benefits in terms of local complications. In this meta-analysis, we aimed to evaluate the utility of DTRA compared to conventional transradial artery access (CTRA) for coronary angiography and intervention.
Multiple databases were searched from inception through May 2021 for all the studies that evaluated the efficacy and safety of DTRA in the coronary field. The primary outcome was the access success rate. The secondary outcomes were periprocedural local complications (site hematoma, radial artery occlusion, and spasm) and procedural characteristics (cannulation, fluoroscopy, procedure, and radial artery compression times). All meta-analyses were conducted using a random-effect model.
A total of 12 studies (including four randomized control trials) with 1634 patients who underwent DTRA vs. 1657 with CTRA were included in the final analysis. The access success rate was similar between the two groups (odds ratio (OR):0.62; 95% confidence interval (CI):0.30-1.26; P = 0.18; I = 61%). DTRA was associated with a statistically significant lower rate of radial artery occlusion (OR:0.36; 95% CI: 0.22-0.59; P < 0.001; I = 0%) but similar rates of radial artery spasm and site hematoma when compared to CTRA. Regarding the procedural characteristics, despite having a longer canulation time (mean difference (min.) [MD] 0.89, 95% CI 0.36-1.42; P < 0.0001), DTRA was associated with shorter compression time and comparable fluoroscopy and procedure times.
Our meta-analysis demonstrates that the DTRA is effective and safe with superiority in preventing radial artery occlusion when compared to CTRA.
由于在局部并发症方面具有潜在优势，远端桡动脉入路（DTRA）最近受到关注。在这项荟萃分析中，我们旨在评估 DTRA 与传统经桡动脉入路（CTRA）在冠状动脉造影和介入治疗中的效用。
从成立到 2021 年 5 月，我们在多个数据库中搜索了所有评估 DTRA 在冠状动脉领域中的疗效和安全性的研究。主要结局是入路成功率。次要结局为围手术期局部并发症（穿刺部位血肿、桡动脉闭塞和痉挛）和手术特点（穿刺、透视、手术和桡动脉压迫时间）。所有荟萃分析均采用随机效应模型进行。
共有 12 项研究（包括 4 项随机对照试验）纳入了 1634 例接受 DTRA 的患者和 1657 例接受 CTRA 的患者，最终纳入了这项分析。两组的入路成功率相似（比值比（OR）：0.62；95%置信区间（CI）：0.30-1.26；P=0.18；I=61%）。与 CTRA 相比，DTRA 桡动脉闭塞的发生率显著降低（OR：0.36；95%CI：0.22-0.59；P<0.001；I=0%），但桡动脉痉挛和穿刺部位血肿的发生率相似。关于手术特点，尽管穿刺时间较长（平均差值（min.）[MD] 0.89，95%CI 0.36-1.42；P<0.0001），但 DTRA 与较短的压迫时间以及可比的透视和手术时间相关。
我们的荟萃分析表明，与 CTRA 相比，DTRA 有效且安全，在预防桡动脉闭塞方面具有优势。
