Galli M, Zerboni S, Politi A, Paone R, Ferrari G
Cardiology Department S. Anna Hospital, Como.
G Ital Cardiol. 1998 Jul;28(7):767-73.
Due to the recent miniaturization of angioplasty equipment, the transradial approach has gained favor as an alternative catheterization method for coronary procedures. The purpose of this study was to assess the practical clinical application of this method.
Between June 1997 and February 1998, one operator (MG) attempted the percutaneous transradial approach in 185 consecutive unselected patients with functional radial arch attested using Allen's test. In this series of patients, 102 interventional procedures, balloon angioplasty including stent implantation, were performed with 6F or 7F guiding catheters.
Radial arterial punctures for diagnostic procedures were performed in 179 patients with a success rate of 97%. In the six failed transradial accesses, the procedure was performed via the transfemoral route. Balloon angioplasty was performed in 29 patients, 28% (33 lesions), PTCA and stent implantation were performed in 73 patients, 72% (80 lesions). Procedural success was achieved in 100 (98.2%). Two PTCA failed due to the impossibility of crossing a total occlusion. During hospitalization, one patient died of unstable angina and poor left ventricular function 7 days after stenting without stent occlusion at angiography. No major complications related to entry site were observed, and no patients required vascular surgery or blood transfusions.
This preliminary experience suggests that coronary procedures can be performed safely using the transradial approach. Access-site complications are virtually eliminated and early ambulation may result in a shortened hospital stay and lower hospital costs.
由于近期血管成形术设备的小型化，经桡动脉途径已成为冠状动脉介入手术的一种替代导管插入方法而受到青睐。本研究的目的是评估该方法在临床实际中的应用。
1997年6月至1998年2月期间，一名操作者（MG）对185例连续入选的、经艾伦试验证实桡动脉弓功能正常的患者尝试进行经皮经桡动脉途径操作。在这组患者中，使用6F或7F引导导管进行了102例介入手术，包括球囊血管成形术及支架植入术。
179例患者进行了用于诊断性操作的桡动脉穿刺，成功率为97%。在6例经桡动脉穿刺失败的病例中，通过经股动脉途径进行了手术。29例患者进行了球囊血管成形术（33处病变，占28%），73例患者进行了经皮冠状动脉腔内血管成形术（PTCA）及支架植入术（80处病变，占72%）。100例（98.2%）手术获得成功。2例PTCA因无法通过完全闭塞病变而失败。住院期间，1例患者在支架植入术后7天死于不稳定型心绞痛及左心室功能不全，血管造影显示支架无闭塞。未观察到与穿刺部位相关的严重并发症，也没有患者需要进行血管手术或输血。
这一初步经验表明，经桡动脉途径可安全地进行冠状动脉介入手术。穿刺部位并发症几乎得以消除，早期活动可能会缩短住院时间并降低住院费用。
