Oliveira Marcos Danillo, Navarro Ednelson C, Caixeta Adriano
Discipline of Cardiology, Interventional Cardiology Unit, Hospital Universitário I, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Interventional Cardiology, Hospital Regional do Vale do Paraíba, Taubaté, Brazil.
Cardiovasc Diagn Ther. 2022 Apr;12(2):208-219. doi: 10.21037/cdt-21-542.
Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients.
In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included.
The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA.
In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible.
作为传统经桡动脉途径的改进方法，远端经桡动脉入路（dTRA）具有多个潜在优势，包括术者和患者舒适度高、止血更快以及近端桡动脉闭塞（RAO）风险更低。我们旨在描述在一个广泛的、前瞻性的所有患者队列中，将dTRA作为常规冠状动脉造影和经皮冠状动脉介入治疗（PCI）的默认入路的真实世界经验。
在DISTRACTION注册研究中，纳入了总共3683例连续的通过dTRA接受冠状动脉手术的所有患者。
患者平均年龄为63.3±13.5岁，66.1%为男性，39.7%患有糖尿病，50.2%表现为急性冠状动脉综合征（ACS）。总体而言，20%的患者患有非ST段抬高型心肌梗死（NSTEMI），22.9%患有ST段抬高型心肌梗死（STEMI），2.6%表现为心源性休克。有2.5%的入路部位交叉，其中16%是通过对侧dTRA进行的；因此，仅77例（2.1%）患者无法成功插入dTRA鞘管。右侧dTRA（rdTRA）是最常用的入路（80.2%），其次是同侧再次dTRA（10.5%）、左侧dTRA（ldTRA）（8.6%）和同时双侧dTRA（0.7%）。所有病例中有60.4%进行了PCI，左前降支是最常治疗的血管（29%）。根据EASY分类，未记录到≥2级的入路部位相关血肿。任何手术后均未记录到手/拇指功能障碍。1例患者发生假性动脉瘤，1例患者出现导丝导致的前臂桡动脉穿孔。没有与dTRA直接相关的重大并发症或重大不良脑血管和心脏事件。
在这个大型、前瞻性、所有患者的注册研究中，采用dTRA作为常规冠状动脉介入治疗的标准似乎是安全可行的。
