Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands.
Department of Cardiology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.
BMJ Open. 2022 Dec 1;12(12):e065693. doi: 10.1136/bmjopen-2022-065693.
Although recently published evidence favours transradial access (TRA) when using large-bore guiding catheters for percutaneous coronary intervention (PCI) of complex coronary lesions, the femoral artery will still be used in a considerate proportion of patients undergoing complex PCI, especially in PCI of chronic total occlusions (CTO). Ultrasound-guided puncture of the femoral artery may reduce clinically relevant access site complications, but robust evidence is lacking up to date.
A total of 542 patients undergoing complex PCI, defined as PCI of CTO, complex bifurcation, heavy calcified lesion or left main, in which the 7-F or 8-F transfemoral access is required, will be randomised to ultrasound-guided puncture or fluoroscopy-guided puncture. The primary outcome is the incidence of the composite end-point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Access site complications and major adverse cardiovascular events up to 1 month will also be compared between both groups.
Ethical approval for the study was granted by the local Ethics Committee ('Medisch Ethische Toetsing Commissie Isala Zwolle') for all Dutch sites, 'Comité Medische Ethiek Ziekenhuis Oost-Limburg' for Hospital Oost-Limburg, 'Comité d'éthique CHU-Charleroi-ISPPC' for Centre Hospilatier Universitaire de Charleroi and 'Ethik Kommission de Ärztekammer Nordrhein' for Elisabeth-Krankenhaus). The trial outcomes will be published in peer-reviewed journals of the concerned literature. The trasound guided nsfemoral access in mplex arge be PCI trial has been administered in the ClinicalTrials.gov database, reference number: NCT03846752.
ClinicalTrials.gov identifier: NCT03846752.
尽管最近发表的证据支持在经皮冠状动脉介入治疗(PCI)复杂冠状动脉病变时使用大口径引导导管时采用经桡动脉入路(TRA),但在接受复杂 PCI 的患者中,股动脉仍将被考虑用于相当一部分患者,特别是在慢性完全闭塞(CTO)的 PCI 中。超声引导下股动脉穿刺可减少有临床意义的入路部位并发症,但目前缺乏强有力的证据。
共纳入 542 例接受复杂 PCI 的患者,定义为 CTO、复杂分叉、重度钙化病变或左主干病变,需要 7-F 或 8-F 经股动脉入路,将随机分为超声引导穿刺或透视引导穿刺组。主要终点是有临床意义的入路部位相关出血和/或需要介入治疗的血管并发症的复合终点发生率。还将比较两组之间的入路部位并发症和 1 个月内主要不良心血管事件。
该研究的伦理批准已获得荷兰所有站点的当地伦理委员会('Isala Zwolle 医学伦理审查委员会')、Hospital Oost-Limburg 的'Comité Medische Ethiek Ziekenhuis Oost-Limburg'、Centre Hospilatier Universitaire de Charleroi 的'Comité d'éthique CHU-Charleroi-ISPPC'和 Ärztekammer Nordrhein 的'Ethik Kommission de'批准。试验结果将发表在相关文献的同行评议期刊上。超声引导下经股动脉入路在复杂 PCI 中的应用研究已在 ClinicalTrials.gov 数据库中注册,注册号:NCT03846752。
ClinicalTrials.gov 标识符:NCT03846752。