Zahedmehr Ali, Dousti Amir, Alemzadeh-Ansari Mohammad Javad, Gharibzadeh Abdullah, Sheibani Mehdi, Mozafarybazargany Mohammadhossein, Firouzi Ata, Abdi Seifollah, Hosseini Zahra, Baay Mohammadreza, Elahifar Armin, Maadani Mohsen, Shakerian Farshad, Kiani Reza, Toreyhi Hossein, Moosavi Jamal, Mohebbi Bahram, Abdi Amir, Khalilipur Ehsan, Sadeghipour Parham
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Assistant Professor of Cardiology, School of Medicine, Tobacco and Health Research, Hormozgan University of Medical Sciences, Iran.
Heliyon. 2024 Oct 16;10(20):e39451. doi: 10.1016/j.heliyon.2024.e39451. eCollection 2024 Oct 30.
The radial approach is now recommended as the default strategy in diagnostic coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) is the most common complication that limits subsequent angiographic procedures through this access. Recently, distal radial access (DRA) has been recommended as an alternative access site. Despite lower RAO rates in DRA in some recent clinical trials, concerns remain regarding possible complications and limitations due to the small size of the distal radial artery.
The present study aimed to compare traditional radial access (TRA) and DRA concerning RAO in percutaneous coronary procedures.
In the present prospective cohort study, percutaneous coronary procedures were performed via DRA or TRA in 2 study groups. All consecutive participants underwent DRA from September 2021 to March 2022 and TRA from April 2022 to June 2022. Ultrasonography was performed preprocedurally in the DRA group, and patients with small distal artery diameters (<2 mm) were excluded. The same 6-Fr sheaths and standard air-filled compression devices were used in both groups. The primary endpoint was RAO in ultrasound sonography on the first postprocedural day, and the secondary endpoints were the success rate, access time, angiography time, radial artery spasms, and vascular access complications.
A total of 298 patients were assigned to the DRA group and 278 to the TRA group. The RAO rate was significantly higher in the TRA group than in the DRA group (10.1 % vs 0.9 %; = 0.0001; OR, 0.08, 95 % CI, 0.01-0.27). The success rate was significantly higher in the TRA group (96 % vs 90.2 %; = 0.009). Access crossovers were done on 12 patients (4.0 %) in the TRA group and 24 patients (9.8 %) in the DRA group ( < 0.001). The mean access time was significantly lower in the TRA group than in the DRA group (1.9 min vs 2.9 min; < 0.001). The mean angiography time did not significantly differ between the groups (10.2 min in the TRA group vs 9.9 min in the DRA group). The rate of radial artery spasms was not significantly different between the 2 groups (13.8 % in the TRA group vs 14.5 % in the DRA group). The rates of access site hematoma (12.4 % vs 2.3 %; < 0.001) and bleeding (10.7 % vs 4.1; = 0.005) were significantly higher in the TRA group.
DRA was safe and feasible with lower rates of RAO and access site complications than TRA. Thus, it could be used as an alternative approach in percutaneous coronary procedures. However, the trade-off for these advantages of DRA is an increase in cross-over rate, and a decrease in puncture success rate.
目前，桡动脉入路被推荐为诊断性冠状动脉造影和经皮冠状动脉介入治疗的默认策略。桡动脉闭塞（RAO）是限制通过该入路进行后续血管造影操作的最常见并发症。最近，远端桡动脉入路（DRA）被推荐为一种替代入路部位。尽管在一些近期临床试验中DRA的RAO发生率较低，但由于远端桡动脉管径较小，对可能的并发症和局限性仍存在担忧。
本研究旨在比较经皮冠状动脉手术中传统桡动脉入路（TRA）和DRA的RAO情况。
在本前瞻性队列研究中，2个研究组分别通过DRA或TRA进行经皮冠状动脉手术。所有连续纳入的参与者在2021年9月至2022年3月接受DRA，在2022年4月至2022年6月接受TRA。DRA组在术前进行超声检查，排除远端动脉直径<2mm的患者。两组均使用相同的6F鞘管和标准充气压迫装置。主要终点是术后第1天超声检查发现的RAO，次要终点是成功率、穿刺时间、血管造影时间、桡动脉痉挛和血管入路并发症。
共298例患者被分配至DRA组，278例患者被分配至TRA组。TRA组的RAO发生率显著高于DRA组（10.1%对0.9%；P=0.0001；OR，0.08，95%CI，0.01-0.27）。TRA组的成功率显著更高（96%对90.2%；P=0.009）。TRA组有12例患者（4.0%）进行了入路转换，DRA组有24例患者（9.8%）进行了入路转换（P<0.001）。TRA组的平均穿刺时间显著低于DRA组（1.9分钟对2.9分钟；P<0.001）。两组间的平均血管造影时间无显著差异（TRA组为10.2分钟，DRA组为9.9分钟）。两组间桡动脉痉挛发生率无显著差异（TRA组为13.8%，DRA组为14.5%）。TRA组的穿刺部位血肿发生率（12.4%对2.3%；P<0.001）和出血发生率（10.7%对4.1%；P=0.005）显著更高。
DRA安全可行，与TRA相比，RAO和穿刺部位并发症发生率更低。因此，它可作为经皮冠状动脉手术的一种替代方法。然而，DRA这些优势的代价是转换率增加和穿刺成功率降低。
