Louvard Y, Pezzano M, Scheers L, Koukoui F, Marien C, Benaim R, Goy P, Lardoux H
Service de cardiologie, hôpital Gilles-de-Corbeil, Corbeil-Essonnes.
Arch Mal Coeur Vaiss. 1998 Feb;91(2):209-15.
The aim of this study was to assess the feasibility of the radial artery approach for coronary angiography in a standard population of presumed coronary patients and to continue the assessment for a sufficiently long period of time to perfect the technique, evaluate the learning curve and prepare a randomised comparison with the femoral approach. The radial artery was used for coronary angiography in 800 patients after exclusion of about 25% of patients, mainly because of a negative Allen's maneuver. With the exception of acute myocardial infarction, there was no selection based on symptoms and transradial catheterisation was attempted irrespective of age, sex, weight or height. The representative nature of the study population was confirmed by the results of the procedure (normal: 20%, single vessel disease: 30%, double vessel disease: 26%, triple vessel disease: 18% and left main disease: 5.4%). The right radial artery was used in 94% of cases. Successful radial puncture/catheterisation was obtained in 97% of cases: 100% of left coronary arteries and 99% of right coronary arteries were catheterised, the left ventricle in 98% of cases, the internal mammary arteries in 100%, and venous bypass grafts in 95%. The average duration of the whole procedure was 19 +/- 9 minutes. This decreased regularly with operator experience and judicious choice of catheters. The best choice seemed to be a single catheter for both coronary arteries, either an Amplatz or a Champ catheter. There were two probably avoidable coronary complications and two transient neurological events but no clinically significant vascular complication. The radial artery seemed to be a good approach for routine coronary angiography and may now be compared with the femoral approach. It should help expand the practice of ambulatory coronary angiography.
本研究的目的是评估在疑似冠心病的标准人群中经桡动脉途径进行冠状动脉造影的可行性，并在足够长的时间内持续评估以完善该技术、评估学习曲线并准备与经股动脉途径进行随机对照比较。在排除约25%的患者后，800例患者采用桡动脉进行冠状动脉造影，主要原因是Allen试验阴性。除急性心肌梗死外，不根据症状进行选择，无论年龄、性别、体重或身高，均尝试经桡动脉插管。手术结果证实了研究人群的代表性（正常：20%，单支血管病变：30%，双支血管病变：26%，三支血管病变：18%，左主干病变：5.4%）。94%的病例使用右桡动脉。97%的病例成功进行了桡动脉穿刺/插管：100%的左冠状动脉和99%的右冠状动脉成功插管，98%的病例成功插入左心室，100%成功插入乳内动脉，95%成功插入静脉旁路移植血管。整个手术的平均时长为19±9分钟。随着术者经验的增加和对导管的合理选择，该时长有规律地缩短。最佳选择似乎是使用一种用于双侧冠状动脉的导管，如Amplatz导管或Champ导管。发生了两例可能可避免的冠状动脉并发症和两例短暂性神经事件，但无具有临床意义的血管并发症。桡动脉似乎是常规冠状动脉造影的良好途径，现在可与股动脉途径进行比较。这应有助于扩大门诊冠状动脉造影的应用。
