Rivera Kristian, Fernández-Rodríguez Diego, García-Guimarães Marcos, Casanova-Sandoval Juan, Irigaray Patricia, Zielonka Marta, Ramírez Martínez Tania, Arroyo-Calpe David, Costa-Mateu Joan, Tornel-Cerezo María, Baiget-Pons Anna, Roig-Boira Oriol, Perelló-Cortí Eduard, Castillo-Peña Xenia, Royo-Beltrán Raquel, Worner Fernando, Ferreiro José Luis
Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, España Servei de Cardiologia Hospital Universitari Arnau de Vilanova Lleida España.
Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida, España Grup de Fisiologia i Patologia Cardíaca Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré IRBLleida Lleida España.
REC Interv Cardiol. 2024 Oct 15;6(4):287-295. doi: 10.24875/RECIC.M24000473. eCollection 2024 Oct-Dec.
Distal radial access (DRA) for coronary procedures is currently recognized as an alternative to conventional transradial access, with documented advantages primarily related to access-related complications. However, widespread adoption of DRA as the default approach remains limited. Therefore, this prospective cohort study aimed to present our initial experience with DRA for coronary procedures in any clinical settings.
From August 2020 to November 2023, we included 1000 DRA procedures (943 patients) conducted at a single center. The study enrolled a diverse patient population. We recommended pre- and postprocedural ultrasound evaluations of the radial artery course, with ultrasound-guided DRA puncture. The primary endpoint was DRA success, while secondary endpoints included coronary procedure success, DRA performance metrics, and the incidence of access-related complications.
The DRA success rate was 97.4% (n = 974), with coronary procedure success at 96.9% (n = 969). The median DRA time was 40 [interquartile range, 30-60] seconds. Diagnostic procedures accounted for 64% (n = 644) of cases, while 36% (n = 356) involved percutaneous coronary intervention (PCI), including primary PCI in 13% (n = 128). Pre-procedure ultrasound evaluation and ultrasound-guided DRA were performed in 83% (n = 830) and 85% (n = 848) of cases, respectively. Access-related complications occurred in 2.9% (n = 29).
This study shows the safety and feasibility of DRA for coronary procedures, particularly when performed under ultrasound guidance in a diverse patient population. High rates of successful access and coronary procedure outcomes were observed, together with a low incidence of access-related complications. The study was registered on ClinicalTrials.gov (NTC06165406).
目前，冠状动脉介入手术的桡动脉远端入路（DRA）被认为是传统经桡动脉入路的一种替代方法，其已记录的优势主要与入路相关并发症有关。然而，DRA作为默认方法的广泛采用仍然有限。因此，这项前瞻性队列研究旨在介绍我们在任何临床环境中使用DRA进行冠状动脉介入手术的初步经验。
从2020年8月至2023年11月，我们纳入了在单一中心进行的1000例DRA手术（943例患者）。该研究纳入了多样化的患者群体。我们建议在术前和术后对桡动脉走行进行超声评估，并采用超声引导下的DRA穿刺。主要终点是DRA成功，次要终点包括冠状动脉介入手术成功、DRA操作指标以及入路相关并发症的发生率。
DRA成功率为97.4%（n = 974），冠状动脉介入手术成功率为96.9%（n = 969）。DRA的中位时间为40[四分位间距，30 - 60]秒。诊断性手术占病例的64%（n = 644），而36%（n = 356）涉及经皮冠状动脉介入治疗（PCI），其中13%（n = 128）为直接PCI。分别有83%（n = 830）和85%（n = 848）的病例进行了术前超声评估和超声引导下的DRA。入路相关并发症的发生率为2.9%（n = 29）。
本研究表明DRA用于冠状动脉介入手术的安全性和可行性，特别是在多样化患者群体中在超声引导下进行时。观察到较高的入路成功率和冠状动脉介入手术结果，以及较低的入路相关并发症发生率。该研究已在ClinicalTrials.gov上注册（NTC06165406）。
