Didagelos Matthaios, Pagiantza Areti, Papazoglou Andreas S, Moysidis Dimitrios V, Petroglou Dimitrios, Daios Stylianos, Anastasiou Vasileios, Theodoropoulos Konstantinos C, Kouparanis Antonios, Zegkos Thomas, Kamperidis Vasileios, Kassimis George, Ziakas Antonios
1st Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece.
424 General Military Hospital, 56429 Thessaloniki, Greece.
J Clin Med. 2024 Jun 1;13(11):3276. doi: 10.3390/jcm13113276.
: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. : We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. : The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05-2.83)), (ii) access site cross-over (aOR = 4.33 (1.02-18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00-1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40-4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28-4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29-20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01-3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70-40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06-0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96-0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31-1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42-14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67-32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46-9.87)), either pain (aOR = 2.93 (1.05-8.15)) or numbness (aOR = 4.66 (1.17-18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04-0.76)) was independently associated with a greater frequency of RAP. : The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.
桡动脉闭塞（RAO）是经桡动脉冠状动脉导管插入术最常见的并发症。在本研究中，我们旨在评估RAO的发生率，并确定使患者易患RAO的危险因素。
我们开展了一项由研究者发起的前瞻性、多中心、开放标签研究，纳入1357例经桡动脉途径进行血管造影和/或经皮冠状动脉介入治疗（PCI）的心脏导管插入术患者。进行单因素和多因素逻辑回归分析以确定RAO发生的潜在预测因素。此外，仅对接受PCI的患者进行了亚组分析。
总体RAO发生率为9.5%，仅行血管造影组为10.6%，PCI组为6.2%。RAO的独立预测因素如下：（i）女性（调整后比值比[aOR]=1.72[1.05 - 2.83]），（ii）穿刺部位交叉（aOR = 4.33[1.02 - 18.39]），（iii）动脉鞘管总留置时间延长（aOR = 1.01[1.00 - 1.02]），（iv）桡动脉痉挛（aOR = 2.47[1.40 - 4.36]），（v）存在血肿（aOR = 2.28[1.28 - 4.06]），（vi）导管插入术后使用达比加群（aOR = 5.15[1.29 - 20.55]），（vii）手法止血（aOR = 1.94[1.01 - 3.72]）以及（viii）桡动脉超声检查时麻木（aOR = 8.25[1.70 - 40]）。相反，有两个变量与桡动脉通畅（RAP）几率增加独立相关：（i）PCI操作（aOR = 0.19[0.06 - 0.63]），以及（ii）每位患者体重的静脉肝素剂量较高（aOR = 0.98[0.96 - 0.99]），特别是剂量>50 IU/kg（aOR = 0.56[0.31 - 1.00]）。在PCI亚组中，RAO的独立预测因素如下：（i）桡动脉痉挛（aOR = 4.48[1.42 - 14.16]），（ii）使用动脉内硝酸甘油作为血管扩张剂（aOR = 7.40[1.67 - 32.79]）以及（iii）超声心动图有症状（aOR = 3.80[1.46 - 9.87]），包括疼痛（aOR = 2.93[1.05 - 8.15]）或麻木（aOR = 4.66[1.17 - 18.57]）。另一方面，使用动脉内维拉帕米作为血管扩张剂（aOR = 0.17[0.04 - 0.76]）与更高的RAP发生率独立相关。
在未选择的、所有来诊的欧洲人群中，经桡动脉冠状动脉导管插入术进行血管造影和/或PCI后的RAO发生率与国际文献报道相似。已证实了几个RAO预后因素，并描述了新的因素。女性、桡动脉创伤和手法止血是RAO最强的预测因素。我们的结果可能有助于未来识别RAO风险较高的患者，若可能，对于这些患者或许更倾向于选择侵入性较小的诊断程序。
