Repeated using ipsilateral distal radial artery approach for coronary angiogram and intervention
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摘要: 目的 探讨反复经同侧远端桡动脉入路行冠状动脉(冠脉)介入诊疗的安全性及可行性。方法 回顾性分析本中心2020年6月—2022年5月反复经远端桡动脉入路行冠脉介入诊疗患者数据。结果 共有142例患者反复经同侧远端桡动脉入路行冠脉介入诊疗，年龄67(60，73)岁，其中男99例(69.72%)。距离上一次同侧远端桡动脉介入手术的时间为2 h~2年，中位时间为7.5(1~12)个月。在142例重复经远端桡动脉介入诊疗患者中，2次124例(87.32%)，3次17例(11.97%)，4次1例(0.70%)；总体穿刺成功率92.96%(132/142)，2次穿刺成功率为93.55%(116/124)，2次以上的成功率为88.89%(16/18)。亚组分析结果表明，女性组重复穿刺成功率为90.70%(39/43)，低于男性组93.94%(93/99)，但是两组间差异无统计学意义。远端桡动脉穿刺部位出血4例，经重新压迫后止血；前臂血肿1例，发生在更换常规桡动脉入路患者中；2例患者再次手术前发现桡动脉闭塞，经穿刺同侧远端桡动脉后开通闭塞桡动脉，同时完成冠脉介入手术。结论 经同侧远端桡动脉入路重复行冠脉介入诊疗安全可行，有一定的临床应用价值。Abstract: Objective To investigate the feasibility and safety of repeated ipsilateral distal radial artery approach(dRA) for coronary intervention.Methods The data of patients who underwent repeated coronary intervention through the ipsilateral dRA in our center from June 2020 to May 2022 were retrospectively analyzed.Results A total of 142 patients underwent repeated coronary intervention through the ipsilateral dRA, aged 67(60, 73) years, and 99 patients(69.72%) were male. The interval time since the last ipsilateral dRA intervention was 2 hours to 2 years, with a median of 7.5(1-12) months. Among them, 124(87.32%) patients were treated twice, 17(11.97%) three times, and 1(0.70%) four times. The total puncture success rate was 92.96%(132/142), the second puncture success rate was 93.55%(116/124), and the success rate more than two times was 88.89%(16/18). The results of subgroup analysis showed that the success rate of repeated puncture in the female group was 90.70%(39/43), which was lower than that in the male group 93.94%(93/99). However, the difference between the two groups was not statistically significant. There were four cases of bleeding at the puncture site, which was stopped after re-compression. One patient with forearm hematoma was found in the conventional radial artery approach. Two patients were found to have radial artery occlusion before repeated operations. The occluded radial artery was recanalization and coronary intervention was completed via successfully puncturing the ipsilateral dRA.Conclusion Repeated coronary intervention through the ipsilateral dRA approach is safe and feasible, and has clinical application value.
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Key words:
- coronary heart disease /
- distal radial artery /
- coronary intervention /
- anatomic snuffbox
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表 1 患者一般临床资料
Table 1. The clinical characteristics
例(%), X±S, M(P25, P75) 项目 总体(142例) 男性(99例) 女性(43例) P 年龄/岁 67(60，73) 65(54，72) 70(67，75) < 0.001 BMI/(kg·m-2) 25.43±3.63 25.72±3.86 24.77±2.97 0.152 收缩压/mmHg 132(125.75，146) 130(124，143) 138(127，148) 0.086 舒张压/mmHg 78(70，83) 78(70，86) 76(74，80) 0.302 心率/(次·min-1) 70(62.75，79) 70(63，78) 70(62，80) 0.584 吸烟史 48(33.80) 48(48.48) 0(0) < 0.001 饮酒史 15(10.56) 15(15.15) 0(0) 0.016 既往病史 高血压病 120(84.51) 80(80.81) 40(93.02) 0.065 糖尿病 63(44.37) 34(34.34) 29(67.44) < 0.001 血脂异常 12(8.45) 9(9.09) 3(6.98) 0.930 冠心病 126(88.73) 86(86.87) 40(93.02) 0.437 脑梗死 7(4.93) 2(2.02) 5(11.63) 0.045 ALT /(U·L-1) 20(16，26.25) 23(18，32) 17(13，20) < 0.001 AST /(U·L-1) 22(19，27) 23(19，29) 21(18，27) 0.079 CR/(μmol·L-1) 76.2(64.875，87.525) 78.7(70.3，89.8) 64.5(57.8，80.4) < 0.001 LDL-C/(mmol·L-1) 1.9(1.5，2.3) 1.80(1.475，2.10) 2.1(1.8，2.7) 0.001 HbA1C/% 6.4(5.9，7.5) 6.2(5.9，6.925) 7.1(6.45，8.3) < 0.001 左室舒张末期内径/mm 49(46，52) 49(47，52.5) 47(45，51) 0.043 左室收缩末期内径/mm 32(30，36) 32(31，35.5) 32(28，36) 0.242 左室射血分数/% 61(57，65) 60(57，64) 62(57，65.5) 0.359 手术类型 0.274 CAG 66(46.48) 49(49.49) 17(39.53) PCI 76(53.52) 50(50.51) 26(60.47) 急诊手术 2(1.41) 1(1.01) 1(2.33) 0.544 右侧远桡 141(99.30) 99(100.00) 42(97.67) 1.000 血管鞘 0.594 5F 2(1.41) 2(2.02) 0(0) 6F 137(96.48) 94(94.95) 43(100) 7F 3(2.11) 3(3.03) 0(0) 手术时间/min 40(20，65) 35(15，60) 50(30，70) 0.065 X线时间/min 9.7(2.6，22.2) 8.8(2.3，19.3) 14.5(3.9，24.9) 0.156 造影剂用量/mL 90(50，150) 80(50，130) 97.5(50，150) 0.322 1 mmHg=0.133 kPa。AST：谷草转氨酶；CAG；冠脉造影；PCI：经皮冠脉介入治疗。 
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表 2 穿刺成功组与失败组临床资料比较
Table 2. Comparison of clinical data between successful puncture group and failure group
例(%), X±S, M(P25, P75) 项目 穿刺成功(132例) 穿刺失败(10例) P 男性 93(70.45) 6(60.00) 0.736 年龄/岁 67(60，73) 66.50(51.75，74.25) 0.978 BMI/(kg·m-2) 25.65±3.59 23.75±3.95 0.129 既往病史 高血压病 112(84.85) 8(80.00) 0.654 糖尿病 56(42.42) 7(70.00) 0.173 血脂异常 11(8.33) 1(10.00) 0.599 冠心病 116(87.88) 10(100.00) 0.516 脑梗死 7(5.30) 0(0) 1.000 收缩压/mmHg 132(126，146) 131(114，151) 0.621 舒张压/mmHg 78(70，83) 76(69，84) 0.675 心率/(次·min-1) 70(62，79) 70(64，76) 0.984 急诊手术 2(1.52) 0(0) 1.000
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表 3 重复同侧远端桡动脉入路手术的安全性
Table 3. Safety of repeated coronary intervention via ipsilateral distal radial artery
例(%) 项目 总体(142例) 2次(124例) > 2次(18例) P 出血 4(2.82) 3(2.42) 1(5.56) 0.422 血肿 1(0.70) 1(0.81) 0(0) 1.000 桡动脉闭塞 2(1.41) 2(1.61) 0(0) 1.000
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