Koziński Łukasz, Orzałkiewicz Zbigniew, Dąbrowska-Kugacka Alicja
Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland.
Department of Cardiology and Electrotherapy, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland.
J Clin Med. 2023 Dec 11;12(24):7608. doi: 10.3390/jcm12247608.
The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38-3.86, = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, < 0.05) and access-time [median: 140s (85-322) vs. 80s (58-127), < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, = 0.41) and mid-term (2.5% vs. 3%, = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96-88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA.
对于接受冠状动脉介入手术的患者，经解剖鼻烟壶的远端桡动脉入路（dTRA）被认为比传统桡动脉入路（cTRA）具有更大的优势。我们的目标是评估dTRA的安全性和有效性。在一项前瞻性单中心试验中，从465例连续的白种人患者中，将400例患者按1:1随机分为dTRA组或cTRA组。在术后24小时和60天进行临床和超声随访。主要联合终点包括入路转换、与入路相关的并发症以及主要不良心血管事件（MACE）。次要终点包括临床成功终点（穿刺成功、入路转换和入路时间）、入路部位并发症终点以及60天时的MACE。dTRA组的主要终点显著更高[比值比（OR）：2.31，95%置信区间（CI）：1.38 - 3.86，P = 0.001]。临床成功终点，即入路转换（10%对3.5%，P < 0.05）和入路时间[中位数：140秒（85 - 322）对80秒（58 - 127），P < 0.001]，并不支持dTRA，尽管dTRA和cTRA的桡动脉穿刺成功率相似（99.5%对99%）。dTRA组桡动脉痉挛（19%对4.5%，P < 0.0001）、入路期间的身体不适以及术后短暂拇指麻木的发生率更高。然而，dTRA和cTRA在前臂桡动脉早期（2.5%对4.5%，P = 0.41）和中期（2.5%对3%，P = 0.98）闭塞率相当。多因素分析中，随机分组至dTRA、较低的前臂桡动脉搏动容积、较高的体重指数和较低的体表面积独立预测主要终点。在交互作用分析中，仅糖尿病增加了dTRA组主要终点的发生率（OR：18.67，95% CI：3.96 - 88.07）。在常规冠状动脉介入手术中，由于动脉痉挛发生率较高以及入路转换的必要性，dTRA是一种不如cTRA有利的策略。dTRA术后的大多数局部并发症为临床轻微并发症。糖尿病患者尤其易发生与dTRA相关的并发症。
