Hildick-Smith D J, Lowe M D, Walsh J T, Ludman P F, Stephens N G, Schofield P M, Stone D L, Shapiro L M, Petch M C
Department of Cardiology, Papworth Hospital, Cambridgeshire, UK.
Int J Cardiol. 1998 May 15;64(3):231-9. doi: 10.1016/s0167-5273(98)00074-6.
to assess the outcomes, complications and limitations of coronary angiography performed via percutaneous radial artery puncture.
two hundred and fifty patients underwent diagnostic coronary angiography from the radial artery, 182 (72.8%) of whom had contraindications to the femoral approach, for example due to peripheral vascular disease (n=85), therapeutic anticoagulation (29), or failed femoral approach (17). Procedural success in this high-risk population was achieved in 231 patients (92.4%). Principle reasons for failure were unsuccessful radial access (5) and arterial spasm (5). Procedure duration (SD) for an operator's first 20 cases compared with cases thereafter (min) was 47.7 (16.7) vs. 41.5 (14.6), P=0.0004; fluoroscopy time (min) 9.7 (7.1) vs. 6.6 (5.1), P=0.0001 and procedural success 89.6% vs. 94.1%, P=ns. Complications included two deaths associated temporally with catheterisation, three cases of arterial dissection without ischaemic sequelae and one transient ischaemic attack.
coronary angiography can be performed successfully from the radial artery, but this approach has limitations, which include the need to demonstrate dual palmar vascular supply, the prolonged learning phase, the procedural failure rate, patient discomfort and a demonstrable incidence of vascular and haemodynamic complications. We believe that radial coronary angiography should only be undertaken when there is a contraindication to the femoral approach.
评估经皮桡动脉穿刺冠状动脉造影的结果、并发症及局限性。
250例患者接受了经桡动脉的诊断性冠状动脉造影，其中182例（72.8%）因股动脉途径存在禁忌证，例如外周血管疾病（n = 85）、治疗性抗凝（29例）或股动脉穿刺失败（17例）。该高危人群中231例（92.4%）手术成功。失败的主要原因是桡动脉穿刺不成功（5例）和动脉痉挛（5例）。操作者前20例手术的操作时间（标准差）与之后的病例相比（分钟）为47.7（16.7）对41.5（14.6），P = 0.0004；透视时间（分钟）9.7（7.1）对6.6（5.1），P = 0.0001，手术成功率89.6%对94.1%，P =无显著差异。并发症包括2例与导管插入术时间相关的死亡、3例无缺血性后遗症的动脉夹层和1例短暂性脑缺血发作。
经桡动脉可成功进行冠状动脉造影，但该方法存在局限性，包括需要证实双掌侧血管供应、学习阶段延长、手术失败率、患者不适以及血管和血流动力学并发症的明显发生率。我们认为，仅在股动脉途径存在禁忌证时才应进行桡动脉冠状动脉造影。
