Comparison of Clinical Value between Right Distal Radial Artery Access and Right Radial Artery Access in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

Objective:To compare the feasibility and safety between right distal radial artery access and right radial artery access in patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI).Methods:On the basis of arterial access,113 patients who underwent CAG or PCI in Kunshan Hospital of Traditional Chinese Medicine between January and October 2018 were divided into two groups:a right distal radial artery group(52 patients)and a right radial artery group(61 patients).We collected general information,the number of puncture attempts,access times,postoperative compression time,and complications.Results:The general characteristics,rate of successful radial artery puncture,and rate of successful catheter placement in the two groups were not different.The right radial artery group had fewer puncture attempts(1.26±0.44 times vs.2.19±0.53 times,P=0.001)and a shorter access time(3.23±0.86 min vs.4.77±1.49 min,P=0.001)than the right distal radial artery group.However,the postoperative compression time in the right distal radial artery group was shorter(3.44±0.9 h vs.7.16±1.21 h,P=0.001).Two cases of bleeding,four cases of hematoma,and one case of artery occlusion in the right radial artery group and one case of hematoma in the right distal artery group occurred before discharge.The rate of total complications in the right distal radial artery group was lower than in the right radial artery group(1.93%vs.11.48%,P=0.048).Conclusion:CAG or PCI through the right distal radial artery is feasible and safe.

Safety and feasibility of transradial coronary intervention in Chinese elderly patients

Objective To assess the feasibility and safety of transradial approach in Chinese elderly patients undergoing coronary intervention.Methods In this prospective study,764 elderly patients with coronary artery disease received percutaneous coronary intervention via either a transradial approach(TRA group)or a transfemoral approach(TFA group).The procedural success rate,success rate of artery access,puncture time,fluoroscopy time,dose of contrast,local complications and post-procedural pulmonary embolism were recorded and compared between 2 groups.Results There was no significant difference of the procedural success rate between the TRA group and the TRF group(96.3%vs.98.2%,P>0.05);there were also no differences of success rate of cannulation,mean fluoroscopy time and mean dose of contrast between the 2 groups.The mean puncture time was longer in the TRA group than in the TFA group(3.8±2.1 min vs.2.0±3.4 min,P<0.05).However,there were fewer access site-related complications in the TRA group than in the TFA group.Post-procedural pulmonary embolism occurred in 2 patients in the TFA group but none in the TRA group.Conclusion Transradial coronary intervention was feasible and safe in most Chinese elderly patients when performed by experienced operators.

Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.

The Evaluation of the Safety and Efficacy of Transradial Coronary Procedures

Objectives To evaluate the safety and efficacy of transradial coronary procedures （TRCP）. Methods The data of 83 cases who accepted transradial coronary angiography （CAG） and transradial percutaneous coronary intervention （PCI） in our department were summarized. The success rates, proximal coronary complications, peripheral vascular complications, severe vagal reflex, mean operation time （MOT）, mean recumbent time （MRT）, mean hospital-staying time （MHT） were analyzed. The data were compared with that of 420 cases of transfemoral coronary procedures （TFCP） in the same period. Results Success rates and proximal coronary complications were similar in both groups. Severe vagal reflexes were less in TRCP group than in TFCP group. MOT was longer in TRCP group. MRT and MHT were shorter in TRCP group. 12（14.5%） radial artery spasm, 3（3.6%） radial artery obstruction, 1 sudden respiratory arrest caused by jugular hematoma were observed in TRCP group. Conclusions The efficacy and safety of TRCP are definite. TRCP is more economical. For the purpose of properly evaluate the peripheral vascular complications of TRCP, it is necessary to pay special attention to radial artery occlusion, radial artery stenosis, and jugular hematoma.

Comparison of distal radial artery access and conventional transradial access for percutaneous coronary intervention

Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.

Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention

Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary procedure was 7.8%. Logistic regression analysis showed that female, small radial artery diameter, diabetes and unsuccessful access at first attempt were the independent predictors of RAS.

Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention

Background More and more percutaneous coronary intervention were done from radial artery approach. But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach. The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention. Methods A total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled. Radial arteriography was performed in all patients to detect the anatomical variations of this vessel. All patients＇ radial and ulnar artery inner diameters were measured using a computer assisted quantification method. A detailed patient history was recorded. Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables （including age, gender, ethnicity, height, weight, body mass index, smoking, diabetes, hypertension and dyslipidemia） in arterial tortuosities and variations of this vessel. Results In southern Chinese populations, there were no significant differences in the diameters of the forearm arteries： the mean radial artery inner diameter was （3.04±0.43） mm in ethnic Han Chinese and （3.05±0.42） mm in ethnic Zhuang Chinese, P 〉0.05）, the mean ulnar artery inner diameter was （3.03±0.38） mm in Han Chinese and （3.05±0.36） mm in Zhuang Chinese, P 〉0.05）. It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients, and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients. The factors found to positively affect the size of the radial artery were sex （bj=0.309, P 〈0.01）, weight （bj=0.103, P 〈0.01 ）, and diabetes mellitus （bj=-0.088, P 〈0.01） was found to negatively affect radial artery size. Arterial tortuosities occurred in 12.1% of patients and arterial variations in 4.1%. The incidence of tortuosities and variations included radial artery tortuosity （3.6%）, high origin of radial artery （1.7%）, radial artery loop （0.6%）, double radial artery （0.1%）, brachial artery tortuosity （0.4%）, double brachial artery （0.1%）, subclavian artery tortuosity （5.4%）, small subclavian artery （0.4%）, right retro-esophageal subclavian artery （0.6%）, brachiocephalic trunk tortuosity （2.8%）, small brachiocephalic artery （0.1%）, and brachiocephalic artery anomaly （0.4%）. For people in Guangxi province, tortuosities of the subclavian artery and radial artery are the most common among the vascular tortuosities of the radial artery approach. The overall rate of transradial procedural success was 96.1%. Procedural failure was more common in patients with anomalous radial artery approach than in patients with normal radial artery approach （22.8% vs. 1.8%, P=0.000）. According to multivariate Logistic regression analysis, age （OR=2.695, 95% CI 2.232-3.253, P=0.000）, female gender （OR=5.127, 95% CI 3.000-8.762, P=0.000）, height （OR=0.612, 95% CI 0.465-0.807, P=0.000）, body mass index （OR=2.377, 95% CI 1.834-3.082, P=0.000）, hypertension （OR=1.668, 95% CI 1.132-2,458, P=0.010）, hyperlipidemia （OR=1.273, 95% CI 1.425-2.049, P=0.034） and smoking （OR=5.750, 95% CI 3.636-9.093, P=0.000）, were independently associated with arterial tortuosities of the radial artery approach. Female gender was independently associated with arterial variations of the radial artery approach （OR=3.613, 95% CI 3.208-7.826, P=0.000）. Conclusions The diameters of the radial and ulnar arteries between the Han people and the Zhuang people in southern Chinese populations are similar. In a transradial operation, the most southern Chinese populations, the use of a 6F sheath and guiding catheter is safe, and using a 7F sheath and guiding catheter is feasible in some selected patients. Radial arterial tortuosities and variations in southern Chinese populations are relatively common and are a significant cause of the failure of transradial coronary procedure. Old age, female gender, short stature, high body mass index,hypertension, hyperlipidemia and smoking, were independently associated with an increased risk of arterial tortuosity. In addition, female gender was an independent predictor of arterial variations.

Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction

Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention （PCI）. Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction （STEMI） patients. We evaluated this on STEMI patients who underwent primary PCI （p-PCI） via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group （n=-72） or placebo group （n=-78）. Angiographic analysis included initial and final thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the thrombotic vessel. Platelet aggregation rate （PAR）, creatine phosphokinase （CPK）, CPK isoenzyme MB （CPK-MB） and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events （MACE） were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group （all P 〈0.05）. Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in addition to aspirin and clopidogrel in STEMI patients with p-PCI via transradial artery access, can quickly inhibit platelet aggregation, loosen occlusive thrombus, improve myocardial reperfusion and reduce incidence of MACE with few complications of vessel access and bleeding.

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention

Background：The risk of radial artery occlusion （RAO） needs particular attention in transradial intervention （TRI）.Therefore,reducing vascular occlusion has an important clinical significance.The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods：We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI.Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.Risk factors for RAO were evaluated using a multivariate model analysis.Results：Of the 606 patients,the RAO occurred in 56 patients.Compared with TRI at 2-5 cm away from the radius styloid process,the odds ratio （OR） for occlusion risk at 0 cm and 1 cm were 9.65 （P =0.033） and 8.90 （P =0.040）,respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 （OR =2.45,P =0.004）.Conclusion：Distal puncture sites （0-1 cm away from the radius styloid process） can lead to a higher rate of RAO.

选择性尺动脉持续循环压迫降低老年冠状动脉介入治疗患者桡动脉闭塞的效果观察

目的 探讨选择性尺动脉持续循环压迫降低老年冠心病行冠状动脉介入治疗患者桡动脉闭塞的效果。方法 选取行冠状动脉介入治疗的450例老年冠心病患者为研究对象,采用随机数字表法分为对照组和试验组,每组225例。对照组术后采取桡动脉非闭塞性压迫,试验组在对照组基础上采用定制的脉搏波血压计进行选择性尺动脉持续循环压迫,持续4 h。比较2组患者穿刺处出血、疼痛、拇指皮温、护士工作量、延时取压率、桡动脉血流速度、术后24 h桡动脉闭塞率和狭窄率等指标。结果 2组患者穿刺处出血、疼痛、拇指皮温、护士工作量和延时取压率等指标比较,差异无统计学意义(P>0.05)。与对照组比较,试验组在解除血压计前0.5 h桡动脉血流速度较快,术后24 h桡动脉闭塞率和狭窄率较低,差异有统计学意义(P<0.05)。结论 在不增加患者出血风险、疼痛、护士工作量和延时取压率的前提下,采用定制脉搏波血压计选择性持续循环压迫4 h可以增加桡动脉血供,降低术后桡动脉闭塞率和狭窄率。

缩短解压间隔时间对经皮冠状动脉介入治疗术后病人的影响

目的:探讨缩短解压间隔时间在经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后病人中的应用效果。方法:便利选取2021年11月-2022年8月入住聊城市某三级甲等综合医院心内科114例行桡动脉PCI的病人作为研究对象,采用随机数字表法分为试验组56例和对照组58例。两组病人住院期间经桡动脉行PCI术后,均接受螺旋式桡动脉压迫止血器止血,试验组至少每1 h解压1次,对照组病人给予常规每2 h解压1次。比较两组桡动脉PCI术后病人桡动脉压迫时间、并发症、舒适度。结果:桡动脉PCI术后病人桡动脉压迫时间比较,试验组(5.1±1.2)h,少于对照组(6.5±2.4)h(P<0.05);在出血并发症方面,差异无统计学意义(P>0.05);在血肿并发症方面,差异无统计学意义(P>0.05);在肿胀并发症方面,试验组和对照组发生率分别为3.6%、20.7%,试验组少于对照组(P<0.05);在皮肤压力性损伤并发症方面,试验组和对照组发生率分别为0.0%、12.1%,试验组少于对照组(P=0.013);在舒适度方面,试验组舒适度为(72.4±7.9)分,对照组舒适度为(54.1±6.3)分,试验组优于对照组(P<0.05)。结论:缩短解压间隔时间能有效缩短经桡动脉行PCI术后病人桡动脉压迫时间,减少并发症,改善病人舒适度,促进病人康复。

冠状动脉介入术后桡动脉狭窄或闭塞的危险因素分析

目的探讨冠状动脉介入术后桡动脉狭窄或闭塞的危险因素。方法收集2021年3月至2024年2月于邯郸市中心医院接受冠状动脉介入术治疗的649例患者的临床资料,按照冠状动脉介入术后是否发生桡动脉狭窄或闭塞将患者分为病例组(n=61)和对照组(n=588)。比较两组患者的临床特征和冠状动脉介入术主要指标,分析冠状动脉介入术后发生桡动脉狭窄或闭塞的危险因素。结果病例组患者的年龄大于对照组患者,糖尿病史、术前C反应蛋白﹥5 mg/L的比例、慢性完全性闭塞的比例和重复经桡动脉入路的比例均高于对照组患者,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,高龄、有糖尿病史、术前C反应蛋白水平升高、慢性完全性闭塞性病变及重复经桡动脉入路均是冠状动脉介入术后发生桡动脉狭窄或闭塞的独立危险因素(P﹤0.05)。结论冠状动脉介入术后桡动脉狭窄或闭塞的发生与多个因素有关,包括高龄、有糖尿病史、术前C反应蛋白水平升高、重复经桡动脉入路以及发生慢性完全性闭塞病变,临床中应对存在这些危险因素的患者加强监测和预防。

壳聚糖止血海绵联合螺旋桡动脉压迫器在经桡动脉冠状动脉介入术后的止血效果研究

目的探讨壳聚糖止血海绵联合螺旋桡动脉压迫器在经桡动脉冠状动脉介入(TRI)术后的止血效果。方法选取2021年4月至2022年7月在江西省人民医院心血管内科四区经桡动脉途径行冠状动脉造影或冠状动脉粥样硬化性心脏病介入治疗的患者295例,采用随机数字表法分为螺旋桡动脉压迫器组(A组,99例)、壳聚糖止血海绵组(B组,98例)及壳聚糖止血海绵联合螺旋桡动脉压迫器组(C组,98例),3组采用对应方法止血。观察记录3组术后桡动脉血管并发症及患者舒适度情况。结果A组、B组及C组术后出血发生率分别为13.1%(13/99)、5.1%(5/98)、3.1%(3/98),术后出血、瘀斑、肢端肿胀发生率3组间差异均有统计学意义(均P<0.05),组间两两比较A组高于C组(均P<0.05)。术后桡骨血肿发生率A组高于C组(P=0.008)。所有患者均未发生术侧严重肢端肿胀及其他严重并发症。C组患者舒适度优于A组(P=0.004)。结论壳聚糖止血海绵联合螺旋桡动脉压迫器在TRI术后总体止血效果优于单独使用螺旋桡动脉压迫器和壳聚糖止血海绵,可减少术后血管并发症发生率,提高患者舒适度,是一种操作简单、舒适度高、并发症少、安全可靠的止血方法。

选择性桡动脉压迫改善冠脉介入治疗老年患者前臂血肿的效果

目的探讨选择性桡动脉压迫对冠脉介入治疗老年患者前臂血肿的改善效果。方法将冠脉介入治疗并发前臂血肿的152例老年患者随机分成对照组与观察组各76例。对照组采用脉搏波多功能血压计普通袖带对前臂血肿进行压迫,观察组采用定制双气囊中空袖带对前臂血肿进行选择性桡动脉压迫。比较两组患者袖带压迫期间拇指皮温、疼痛评分、手部肿胀程度、舒适度、心率、血压;袖带压迫解除前手部麻木与解除后前臂周径、袖带压迫一次性有效率。结果袖带压迫期间,观察组拇指皮温、疼痛评分、手部肿胀程度、舒适度、心率、血压、手部麻木程度显著优于对照组(均P<0.05);袖带压迫解除后,两组周径、压迫一次性有效率比较,差异无统计学意义(均P>0.05)。结论对冠脉介入治疗并发前臂血肿老年患者应用定制双气囊中空袖带进行选择性桡动脉压迫,在保证袖带有效压迫效果的同时,不影响尺动脉、尺静脉前向血流,可提高患者袖带压迫期间的舒适度。

早期减压对经远端桡动脉行冠状动脉介入术患者的安全性

目的探讨经远端桡动脉行冠状动脉介入术后不同时间减压的安全性。方法选取2022年12月—2023年12月在南京医科大学第一附属医院心血管内科经远端桡动脉入径行冠状动脉造影介入治疗的139例患者作为研究对象,采用随机数字表法分为三组。A组47例,术后30 min首次减压;B组47例,术后1 h首次减压;C组45例,术后2 h首次减压。比较各组术后即刻、30 min、1 h、2 h、4 h术侧肢体疼痛评分、舒适度评分、手掌周径肿胀率及术后穿刺处出血情况。结果术后即刻各组的疼痛评分、舒适度评分及手掌周径肿胀率比较,差异均无统计学意义(P>0.05),A组术后30 min、1 h、2 h、4 h的肢体疼痛评分低于B组与C组(P<0.05),舒适度评分高于B组与C组(P<0.05);A组在术后1 h、2 h、4 h的手掌肿胀率低于B组与C组(P<0.05);各组术后穿刺处出血情况比较,差异均无统计学意义(P>0.05)。结论经远端桡动脉行冠状动脉介入术的患者采用术后30 min首次减压安全有效,且可显著缓解疼痛、肿胀不适感,提高舒适度,值得在临床工作中推广。

经远端桡动脉穿刺行经皮冠脉介入治疗在冠心病合并肾功能不全患者中的应用

目的:探讨经远端桡动脉穿刺行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)在冠心病合并肾功能不全患者中的应用。方法:选取萍乡市人民医院自2022年7月—2023年6月收治的60例冠心病合并肾功能不全患者,采用随机数字表法分为对照组和观察组,各30例。对照组进行桡动脉穿刺PCI手术,观察组采用经远端桡动脉穿刺PCI手术。比较两组一次穿刺和手术的成功率、临床相关指标、数字评价量表(numerical rating scale,NRS)评分、住院时间及手术并发症发生情况。结果:两组一次穿刺和手术成功率进行比较,差异均无统计学意义(P>0.05)。观察组穿刺时间较对照组长,术后压迫止血时间较对照组短,差异均有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05)。观察组NRS评分显著低于对照组,差异有统计学意义(P<0.05)。两组住院时间比较,差异无统计学意义(P>0.05)。观察组的手术并发症发生率相较于对照组低,差异有统计学意义(P<0.05)。结论:经远端桡动脉穿刺行PCI在冠心病合并肾功能不全患者中应用效果较好,有较高的一次穿刺成功率和手术成功率,能显著缩短术后压迫止血时间并有效缓解患者疼痛,同时显著降低手术并发症,安全性较好。

缺血预处理对冠状动脉介入术围手术期桡动脉并发症的影响

目的探讨缺血预处理对冠状动脉介入术围手术期桡动脉并发症的影响。方法收集2019年2月至2023年4月于首都医科大学附属北京积水潭医院接受冠状动脉介入术的193例冠状动脉粥样硬化性心脏病(CHD)患者的临床资料,按照干预方法的不同将其分为干预组(n=89)和对照组(n=104),比较两组患者冠状动脉介入术围手术期桡动脉并发症发生率。结果住院期间共发生桡动脉并发症65例,其中,干预组患者桡动脉并发症总发生率为25.8%(23/89),对照组患者为40.4%(42/104),两组比较,差异有统计学意义(P﹤0.05)。干预组患者桡动脉痉挛、狭窄发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者穿刺部位出血、迷走神经反射发生率比较,差异均无统计学意义(P﹥0.05)。干预组患者发生2种桡动脉并发症的比例低于对照组患者,差异有统计学意义(P﹤0.05)。结论缺血预处理可以显著降低冠状动脉介入术围手术期桡动脉并发症发生率,值得临床推广。

指舞运动在经桡冠状动脉介入术后预防桡动脉闭塞的效果评价

目的:探索经桡介入术后的指舞运动对于桡动脉闭塞(RAO)的预防效果。动态观测病人术后桡动脉血流动力学参数变化情况,分析指舞运动对于早期和晚期RAO的影响。方法:纳入择期行冠状动脉造影及介入治疗的171例病人,随机分为对照组89例和观察组82例。观察组在术后开展3 h的指舞运动,对照组无上述操作。分别在穿刺前、术后第3天和术后1个月检测2组病人桡动脉内膜厚度、直径以及血流速度峰值等指标,动态观测上述指标的变化,分析早期和晚期RAO情况。结果:2组病人的年龄、性别、吸烟、合并疾病等临床特征差异均无统计学意义(P>0.05)。观察组桡动脉直径以及内膜厚度在术前、术后3 d及术后1个月与同时期对照组相比差异均无统计学意义(P>0.05),观察组病人的桡动脉血流速度峰值在术前与对照组病人相比差异无统计学意义(P>0.05),但观察组桡动脉血流速度峰值在术后3 d及术后1个月均高于对照组(P<0.05)。术后3 d,观察组早期RAO率为5.7%(4/70),低于对照组的16.3%(13/80)(P<0.05)。术后1个月,观察组未发生RAO,闭塞率为0%(0/68),低于对照组的14.9%(11/74)(P<0.01)。观察组前臂肿胀及穿刺点渗血等不良反应发生率与对照组相比差异无统计学意义(P>0.05)。结论:指舞运动有助于提升早期桡动脉血流速度,能显著降低冠状动脉造影术后早期和晚期RAO的发生,且未明显影响不良反应发生率。术后指舞运动是一种简便、安全有效的RAO防治策略。

经远端桡动脉冠脉介入对糖尿病患者桡动脉血流动力学及支架管径的影响研究

目的:探讨经远端桡动脉入路冠脉介入对糖尿病患者桡动脉血流动力学及支架管径的影响。方法:选取2022年1月~2023年10月广西医科大学附属武鸣医院行冠脉介入的糖尿病患者92例作为研究对象。根据术前桡动脉及远端桡动脉超声结果,采取数字分配法将患者分为试验组和对照组。试验组采用远端桡动脉穿刺方法,对照组采用常规桡动脉穿刺方法。观察两组手术前后48 h的穿刺动脉内径、血液流速、支架直径以及术后并发症情况。结果:试验组术前及术后48 h桡动脉的内径变化比较(2.86±0.25 mm,2.82±0.26 mm),差异有统计学意义(P<0.01);试验组术前桡动脉血液流速与术后比较(42.43±1.57,42.13±1.77),差异无统计学意义(P>0.05);试验组及对照组术中使用的支架管径[(3.25±0.48)mm,(3.17±0.44)mm],差异无统计学意义(P>0.05);试验组患者未发现明显并发症。结论:远端桡动脉路径在糖尿病患者的冠脉介入诊疗中对桡动脉的血流动力学及支架管径无明显影响。

经桡动脉冠状动脉介入治疗后穿刺点压迫管理的范围综述

目的 对经桡动脉冠状动脉介入治疗后穿刺点压迫管理相关研究进行范围综述,为控制术后出血、降低并发症发生率,减轻患者术肢不适及完善穿刺点压迫管理等提供参考。方法 检索PubMed、Cochrane Library、Web of Science、中国知网、万方和中国生物医学文献数据库中与经桡动脉冠状动脉介入治疗后穿刺点压迫管理相关的研究。检索时限为2013年2月至2023年2月。结果 最终纳入文献19篇,其中系统评价4篇、随机对照研究14篇、类实验性研究1篇。归纳出5种经桡动脉介入治疗后穿刺点压迫方法,其中最推荐气囊式压迫器,其次是螺旋式压迫器;首次放气时间建议提前至术后1 h,以最大程度提高患者舒适度、减少对术肢的影响。结论 压迫器及新型压迫方法较传统压迫方法对于经桡动脉介入治疗后穿刺点压迫更为有效,并建议将首次减压时间从术后4~6 h提前至术后1 h。未来研究可开展基于理论基础的个性化干预措施探索,以构建更加科学、合理的穿刺点压迫管理方法。