Jolimont Hospital, Rue Ferrer, 159, La Louvière, Belgium.
J Invasive Cardiol. 2022 Nov;34(11):E757-E762. doi: 10.25270/jic/22.00049. Epub 2022 Sep 16.
We aim to investigate the safety and efficacy of a new technique, "RailTracking," in the management of challenging transradial routes during percutaneous coronary interventions (PCI).
The transradial access (TRA) currently represents the access site of choice in PCI, but complex anatomy could lead to complications and access-site crossover. The assisted-tracking techniques described in the past (such as balloon-assisted tracking and pigtail-assisted tracking) are based on the concept of a "guiding tapered tip" to improve trackability. The RailTracking technique creates a tapered catheter tip using a dedicated device.
We collected patient data from January 2021 to January 2022 in 2 high-volume centers using the RailTracking technique as a bail-out solution. A prospective analysis of the anatomical characteristics and outcomes of the study population was performed.
Seventy-seven patients were included in the study. All patients presented with challenging anatomies; 35.1% of the patients (n = 27) had small radial arteries, 19.5% (n = 15) had significant radial tortuosity, 2.6% (n = 2) had significant brachial tortuosity, 2.6% (n = 2) had subclavian tortuosity, and 1.29% (n = 1) had a critical subclavian lesion. In addition, 38.9% presented with severe radial spasm. The procedural success rate of the RailTracking technique was 98.7% (76/77 patients). The only case of failure presented with calcifications and a critical lesion in the subclavian artery. However, no periprocedural vascular complications occurred. This new technique appears safe, with a radial artery occlusion rate of 3.89% (n = 3) at 1-month follow-up.
The new RailTracking technique improves catheter crossing in challenging anatomies and seems safe and effective in cases of failure with currently available approaches.
我们旨在研究一种新的技术“RailTracking”在经皮冠状动脉介入治疗（PCI）中处理挑战性经桡动脉入路的安全性和有效性。
经桡动脉入路（TRA）目前是 PCI 的首选入路，但复杂的解剖结构可能导致并发症和入路交叉。过去描述的辅助跟踪技术（如球囊辅助跟踪和猪尾辅助跟踪）基于“引导渐缩尖端”的概念，以提高可跟踪性。RailTracking 技术使用专用设备创建渐缩导管尖端。
我们在 2 家高容量中心收集了 2021 年 1 月至 2022 年 1 月期间使用 RailTracking 技术作为紧急解决方案的患者数据。对研究人群的解剖特征和结果进行了前瞻性分析。
本研究共纳入 77 例患者。所有患者均存在挑战性的解剖结构；35.1%的患者（n=27）桡动脉较小，19.5%（n=15）桡动脉明显迂曲，2.6%（n=2）肱动脉明显迂曲，2.6%（n=2）锁骨下动脉迂曲，1.29%（n=1）锁骨下动脉严重病变。此外，38.9%的患者出现严重桡动脉痉挛。RailTracking 技术的手术成功率为 98.7%（77/77 例患者）。唯一失败的病例表现为锁骨下动脉钙化和严重病变。然而，无围手术期血管并发症发生。这种新技术似乎是安全的，1 个月随访时桡动脉闭塞率为 3.89%（n=3）。
新的 RailTracking 技术可改善在挑战性解剖结构中的导管穿越，在目前可用方法失败的情况下似乎是安全有效的。
