Sciahbasi Alessandro, Cristiano Ernesto, Romagnoli Enrico, Pennacchi Mauro, Belloni Flavia, Zilio Filippo, Occhiuzzi Enrico, Mancone Massimo, Talanas Giuseppe, Marrangoni Alberto, Minardi Simona, Musto Carmine, Mattaroccia Giulia, Rigattieri Stefano
Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy.
Department of Electrophysiology, Humanitas Gavazzeni, Bergamo, Italy.
Int J Cardiol. 2025 Oct 15;437:133523. doi: 10.1016/j.ijcard.2025.133523. Epub 2025 Jun 17.
Transradial approach (TRA), compared with transfemoral, reduces vascular and bleeding complications during percutaneous coronary procedures (PCP) at the expense of a higher conversion rate to another vascular access. Aim of our study was to evaluate the crossover rate and direction (other arm vs femoral access) after primary TRA failure and to assess the clinical impact of access-site crossover.
From July 2022 to January 2025, at 10 experienced radial Centers, we prospectively enrolled all patients with attempted TRA requiring vascular crossover. A control group of effective TRA procedures (with a rate of 2:1 compared to crossover) was also included. Primary endpoint was the rate of in-hospital vascular complications and major bleeding in crossover versus non-crossover groups. Univariate and multivariate analyses were performed to determine independent predictors of TRA crossover.
Among 17,462 undergoing TRA-PCP, vascular crossover was needed in 462 patients (2.6 %) and the second alternative vascular access was femoral in the majority of cases (53 %). Compared to controls (895 patients), the rate of major bleeding and vascular complications was significantly higher in the crossover group (7 % vs 1 %, p < 0.001). Patients undergoing femoral access after TRA failure showed higher bleeding and vascular complications compared to patients with a "full arm" approach (9 % vs 3 %, p < 0.001). Female sex was an independent factor associated with a higher rate of crossover, bleeding and vascular complications in the multivariable analysis.
The crossover rate during TRA-PCP is low but associated with increased vascular and bleeding complications in particular when a femoral access is required.
与经股动脉途径相比，经桡动脉途径（TRA）在经皮冠状动脉介入治疗（PCP）期间可减少血管和出血并发症，但代价是转换为其他血管通路的发生率更高。我们研究的目的是评估初次TRA失败后的交叉率和方向（对侧手臂与股动脉通路），并评估通路部位交叉的临床影响。
从2022年7月至2025年1月，在10个经验丰富的桡动脉中心，我们前瞻性纳入了所有尝试TRA且需要血管交叉的患者。还纳入了一组有效的TRA手术对照组（与交叉组的比例为2:1）。主要终点是交叉组与非交叉组的院内血管并发症和大出血发生率。进行单因素和多因素分析以确定TRA交叉术的独立预测因素。
在17462例接受TRA-PCP的患者中，462例患者（2.6%）需要血管交叉，大多数情况下（53%）的第二备用血管通路是股动脉。与对照组（895例患者）相比，交叉组的大出血和血管并发症发生率显著更高（7%对1%，p<0.001）。TRA失败后接受股动脉通路的患者与采用“全手臂”途径的患者相比，出血和血管并发症更高（9%对3%，p<0.001）。在多变量分析中，女性是与交叉、出血和血管并发症发生率较高相关的独立因素。
TRA-PCP期间的交叉率较低，但与血管和出血并发症增加相关，特别是在需要股动脉通路时。
