Chatelain P, Arceo A, Rombaut E, Verin V, Urban P
Cardiology Center, University Hospital of Geneva, Switzerland.
Cathet Cardiovasc Diagn. 1997 Mar;40(3):297-300. doi: 10.1002/(sici)1097-0304(199703)40:3<297::aid-ccd18>3.0.co;2-m.
Recently the transradial route has emerged as a valuable alternative to the femoral approach for coronary angiography and angioplasty. However, sheath and catheter size and their immediate removal after the procedure, combined with aggressive antiplatelet and anticoagulant therapies, have favored mechanical compression of the radial artery to achieve satisfactory hemostasis. We report on our initial clinical experience with a new device specially designed for prolonged controlled mechanical compression of the radial artery (the RadiStop radial compression system, RADI Medical Systems AB, Uppsala, Sweden). A total of 159 consecutive patients (mean age 60 +/- 11 yr, 130 males) who required either coronary angiography (group 1, 103 patients) or ad hoc or elective coronary angioplasty (group 2, 56 patients) via the right radial route had local hemostasis with the RadiStop system. In group 1, 4F and 5F sheaths and catheters were used, whereas in group 2, 6F systems were inserted in the radial artery. Hemostasis was achieved with the device in all patients but was considered difficult to obtain in 4 patients (2.5%). Twenty-eight patients (18%) considered the device uncomfortable or painful, but no release of pressure was necessary. The mean compression time was 151 +/- 82 min (114 +/- 64 min in group 1, and 223 +/- 64 min in group 2; P = 0.0001). There were 23 local complications (15%). In 7 patients (4.4%), the radial pulse was absent after compression and at discharge, without major clinical consequences. In one patient, recurrent bleeding occurred 2 hr after compression, requiring a new compression session. In 15 patients, a small local hematoma was observed. Neither heparin dosage nor the use of a 6F sheath affected the rate of radial artery patency in this survey. We conclude that the use of this device for mechanical compression of the radial artery after coronary angiography and angioplasty is efficient, and that its use is related to an acceptable rate of local complications.
最近，经桡动脉途径已成为冠状动脉造影和血管成形术的一种有价值的替代股动脉途径的方法。然而，鞘管和导管的尺寸以及术后立即拔除，再加上积极的抗血小板和抗凝治疗，使得对桡动脉进行机械压迫以实现满意的止血成为首选。我们报告了我们使用一种专门设计用于对桡动脉进行长时间控制性机械压迫的新装置（RadiStop桡动脉压迫系统，瑞典乌普萨拉RADI医疗系统公司）的初步临床经验。共有159例连续患者（平均年龄60±11岁，男性130例）通过右桡动脉途径进行冠状动脉造影（第1组，103例患者）或临时或择期冠状动脉血管成形术（第2组，56例患者），使用RadiStop系统实现了局部止血。在第1组中，使用了4F和5F鞘管及导管，而在第2组中，将6F系统插入桡动脉。所有患者均通过该装置实现了止血，但有4例患者（2.5%）被认为止血困难。28例患者（18%）认为该装置不舒服或疼痛，但无需释放压力。平均压迫时间为151±82分钟（第1组为114±64分钟，第2组为223±64分钟；P = 0.0001）。有23例局部并发症（15%）。7例患者（4.4%）在压迫后及出院时桡动脉搏动消失，但无重大临床后果。1例患者在压迫后2小时出现复发性出血，需要重新进行压迫。15例患者观察到小的局部血肿。在本次研究中，肝素剂量和6F鞘管的使用均未影响桡动脉通畅率。我们得出结论，在冠状动脉造影和血管成形术后使用该装置对桡动脉进行机械压迫是有效的，且其使用与可接受的局部并发症发生率相关。
