Tehrani Behnam N, Sherwood Matthew W, Damluji Abdulla A, Epps Kelly C, Bakhshi Hooman, Cilia Lindsey, Dassanayake Isuru, Eltebaney Moemen, Gattani Raghav, Howard Edward, Kepplinger David, Ofosu-Somuah Araba, Batchelor Wayne B
medRxiv. 2023 Jul 6:2023.07.05.23292274. doi: 10.1101/2023.07.05.23292274.
Distal transradial access (dTRA) is an alternative to conventional forearm transradial access (fTRA) for coronary angiography (CAG). Differences in healing of the radial artery in the forearm (FRA) have not been evaluated between these 2 access strategies. We sought to compare FRA intimal-medial thickening (IMT) in patients randomized to dTRA vs. fTRA for CAG.
Sixty-four consecutive patients undergoing non-emergent CAG were randomized (1:1) to dTRA vs. fTRA. Ultrahigh resolution (55 MHz) vascular ultrasound) of the FRA and distal RA was performed pre-CAG and at 90 days. Primary endpoint was 90-day FRA IMT. Secondary endpoints included procedural characteristics, vascular injury, RA occlusion and ipsilateral hand pain and function. Baseline demographics and clinical characteristics, mean FRA IMT, time to RA access, procedure time, and radiation exposure were similar between the dTRA and fTRA cohorts. There were no between group differences in 90-day FRA IMT (0.37 mm vs 0.38 mm, respectively; =0.73). No RA occlusions or signs of major vascular injury were observed at 90 days. Ipsilateral hand pain and function (Borg pain scale:12 vs 11, =0.24; DASH scores: 6 vs 8, =0.46) were comparable.
In this single center randomized clinical trial, similar patterns of FRA vascular healing at 90 days, procedural results as well as hand pain and function were observed following dTRA vs. fTRA for CAG. Further investigation is warranted to better understand the mechanistics and predictors of RA healing and to identify strategies aimed at preserving RA integrity for future procedures.
WHAT IS NEW?: DTRA has been proposed as an alternative to traditional fTRA in the wrist for CAG and PCI because of ergonomic and post-procedural recovery benefits to the patient, as well as potential reductions in occlusion of the FRA.There are gaps in knowledge, however, regarding potential differences in remodeling of the FRA in patients undergoing dTRA versus fTRA.In this randomized clinical trial, there were no differences in IMT and patterns of vascular injury and healing, using ultrahigh resolution (55 MHz) ultrasound, at 90 days in patients randomized to dTRA or FTRA for elective and non-emergent CAG and PCI.
Our findings highlight the need for further inquiry through large multicenter randomized clinical trials to better the understand the mechanistics and predictors of IMT and to identify strategies to mitigate the adverse effects of vessel remodeling in patients undergoing TRA across the entire severity spectrum of cardiovascular disease.
对于冠状动脉造影（CAG），桡动脉远端入路（dTRA）是传统前臂桡动脉入路（fTRA）的一种替代方法。这两种入路策略之间，前臂桡动脉（FRA）愈合情况的差异尚未得到评估。我们旨在比较随机接受dTRA与fTRA进行CAG的患者的FRA内膜 - 中膜增厚（IMT）情况。
连续64例接受非急诊CAG的患者被随机（1:1）分为dTRA组和fTRA组。在CAG术前及术后90天，使用超高分辨率（55 MHz）血管超声对FRA和桡动脉远端进行检查。主要终点是90天的FRA IMT。次要终点包括手术特征、血管损伤、桡动脉闭塞以及同侧手部疼痛和功能。dTRA组和fTRA组之间的基线人口统计学和临床特征、平均FRA IMT、桡动脉入路时间、手术时间和辐射暴露情况相似。90天的FRA IMT在两组之间没有差异（分别为0.37 mm和0.38 mm；P = 0.73）。90天时未观察到桡动脉闭塞或重大血管损伤的迹象。同侧手部疼痛和功能（Borg疼痛量表：12比11，P = 0.24；DASH评分：6比8，P = 0.46）具有可比性。
在这项单中心随机临床试验中，对于CAG，dTRA与fTRA术后90天FRA血管愈合模式、手术结果以及手部疼痛和功能相似。有必要进行进一步研究，以更好地了解桡动脉愈合的机制和预测因素，并确定旨在为未来手术保留桡动脉完整性的策略。
新发现是什么？：由于对患者在人体工程学和术后恢复方面有益，以及可能减少FRA闭塞，dTRA已被提议作为腕部传统fTRA用于CAG和PCI的替代方法。然而，对于接受dTRA与fTRA的患者，FRA重塑的潜在差异存在知识空白。在这项随机临床试验中，对于接受择期和非急诊CAG及PCI的患者，随机分为dTRA或FTRA组，使用超高分辨率（55 MHz）超声在90天时，IMT以及血管损伤和愈合模式没有差异。
临床意义是什么？：我们的研究结果强调需要通过大型多中心随机临床试验进行进一步探究，以更好地理解IMT的机制和预测因素，并确定减轻整个心血管疾病严重程度范围内接受TRA患者血管重塑不良反应的策略。
