Feghaly Julien, Chen Kai, Blanco Anamarys, Pineda Andres M
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
Catheter Cardiovasc Interv. 2023 Mar;101(4):722-736. doi: 10.1002/ccd.30602. Epub 2023 Feb 19.
The distal radial artery (DRA) access is an alternative to the conventional radial artery (CRA) access for coronary angiography and interventions and appears to be associated with reduced incidence of certain outcomes.
A systematic review was performed to evaluate differences between DRA versus CRA access for coronary angiography and/or interventions. Following preferred reporting items for systematic review and meta-analysis-protocols guidelines, two reviewers independently selected studies published in the electronic databases (MEDLINE, EMBASE, SCOPUS, CENTRAL) from inception to October 10, 2022, followed by data extraction, meta-analysis, and quality assessment.
The final review included 28 studies with (total: 9151 patients [DRA: 4474; CRA: 4677]). Compared with CRA, DRA access was found to be associated with a shorter time to achieve hemostasis (mean difference, MD: -32.49 [95% confidence interval, CI: -65.53, -2.46], p < 0.00001), and reduced incidence of radial artery occlusion (RAO) (risk ratio, RR: 0.38 [95% CI: 0.25, 0.57], p < 0.00001), any bleeding (RR: 0.44 [95% CI: 0.22, 0.86], p = 0.02), and pseudoaneurysm (RR: 0.41 [95% CI: 0.18, 0.99], p = 0.05). However, DRA access has increased access time (MD: 0.31 [95% CI: -0.09, 0.71], p < 0.00001) and crossover rates (RR: 2.75 [95% CI: 1.70, 4.44], p < 0.00001). There were no statistically significant differences in other technical aspects and complications.
DRA access is a safe and feasible approach for coronary angiography and interventions. Compared to CRA, DRA provides a shorter hemostasis time, lower incidence of RAO, any bleeding, and pseudoaneurysm, and is associated with increased access time and crossover rates.
桡动脉远端（DRA）入路是冠状动脉造影和介入治疗中传统桡动脉（CRA）入路的一种替代方法，似乎与某些结局的发生率降低有关。
进行了一项系统评价，以评估冠状动脉造影和/或介入治疗中DRA与CRA入路之间的差异。按照系统评价和Meta分析方案的首选报告项目指南，两名研究者独立筛选了从数据库建立至2022年10月10日在电子数据库（MEDLINE、EMBASE、SCOPUS、CENTRAL）中发表的研究，随后进行数据提取、Meta分析和质量评估。
最终评价纳入28项研究（共9151例患者[DRA：4474例；CRA：4677例]）。与CRA相比，发现DRA入路止血时间更短（平均差，MD：-32.49[95%置信区间，CI：-65.53，-2.46]，p<0.00001），桡动脉闭塞（RAO）发生率降低（风险比，RR：0.38[95%CI：0.25，0.57]，p<0.00001），任何出血的发生率降低（RR：0.44[95%CI：0.22，0.86]，p=0.02），以及假性动脉瘤的发生率降低（RR：0.41[95%CI：0.18，0.99]，p=0.05）。然而，DRA入路增加了穿刺时间（MD：0.31[95%CI：-0.09，0.71]，p<0.00001）和交叉率（RR：2.75[95%CI：1.70，4.44]，p<0.00001）。在其他技术方面和并发症方面没有统计学上的显著差异。
DRA入路是冠状动脉造影和介入治疗的一种安全可行的方法。与CRA相比，DRA止血时间更短，RAO、任何出血和假性动脉瘤的发生率更低，且与穿刺时间增加和交叉率增加有关。
