Ikuta Akihiro, Kubo Shunsuke, Osakada Kohei, Takamatsu Makoto, Takahashi Kotaro, Ohya Masanobu, Tanaka Hiroyuki, Tada Takeshi, Fuku Yasushi, Kadota Kazushige
Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki, 710-8602, Japan.
Heart Vessels. 2023 Feb;38(2):147-156. doi: 10.1007/s00380-022-02152-6. Epub 2022 Aug 16.
The distal radial approach (DRA) has been proposed as an alternative approach for coronary angiography (CAG) and percutaneous coronary intervention (PCI); however, the predictors of DRA failure and puncture site complications are unclear. Among 7153 consecutive patients undergoing CAG or PCI between November 2018 and January 2021, 3610 patients undergoing CAG or PCI with DRA were analyzed. The primary endpoint of this study was the procedural success, and the secondary endpoint of this study was puncture site complications during procedure. Puncture site complications during procedure were defined as a composite of major bleeding, minor bleeding, arteriovenous fistula, pseudoaneurysm, and neuropathy. The DRA success rate and the puncture site complication rate were 90.4% and 7.7%, respectively. The predictors of DRA failure were low body weight and dual antiplatelet therapy; those of DRA success were PCI and ultrasonography-guided DRA; those of puncture site complications during procedure were low body weight, peripheral arterial disease, dual antiplatelet therapy, anticoagulant therapy, and PCI; and that of no puncture site complications were previous PCI and ultrasonography-guided DRA. The negative predictors of DRA success with no puncture site complication during procedure were low body weight and dual antiplatelet therapy. The positive predictor of DRA success with no puncture site complication during procedure was ultrasonography-guided DRA. We identified the predictors of DRA failure and puncture site complications during procedure in patients undergoing CAG and PCI with DRA. Ultrasonography-guided DRA was associated with a high DRA success rate and a low puncture site complication rate in patients undergoing CAG or PCI with DRA.
桡动脉远端入路（DRA）已被提议作为冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）的替代入路；然而，DRA失败和穿刺部位并发症的预测因素尚不清楚。在2018年11月至2021年1月期间连续接受CAG或PCI的7153例患者中，对3610例接受DRA进行CAG或PCI的患者进行了分析。本研究的主要终点是手术成功，次要终点是手术期间的穿刺部位并发症。手术期间的穿刺部位并发症被定义为大出血、小出血、动静脉瘘、假性动脉瘤和神经病变的综合。DRA成功率和穿刺部位并发症发生率分别为90.4%和7.7%。DRA失败的预测因素是低体重和双联抗血小板治疗；DRA成功的预测因素是PCI和超声引导下的DRA；手术期间穿刺部位并发症的预测因素是低体重、外周动脉疾病、双联抗血小板治疗、抗凝治疗和PCI；无穿刺部位并发症的预测因素是既往PCI和超声引导下的DRA。手术期间无穿刺部位并发症的DRA成功的阴性预测因素是低体重和双联抗血小板治疗。手术期间无穿刺部位并发症的DRA成功的阳性预测因素是超声引导下的DRA。我们确定了接受DRA进行CAG和PCI的患者手术期间DRA失败和穿刺部位并发症的预测因素。超声引导下的DRA与接受DRA进行CAG或PCI的患者的高DRA成功率和低穿刺部位并发症发生率相关。
