经鼻烟壶区远端桡动脉二次冠脉介入手术的有效性、安全性和手术时机的分析 后印本

Краткое изложение: Background Intervention of coronary artery disease via distal radial artery access (dTRA) in the snuffbox area can significantly reduce the incidence of radial artery occlusion. However, repeated application via dTRA has not been reported domestically. Objective The study aimed to analyze the effectiveness and safety of secondary coronary artery intervention via dTRA retrospectively, as well as to analyze temporal effect on effectiveness and safety of dTRA intervention. Methods In this study, patients who underwent secondary coronary intervention via dTRA in Fuwai Hospital from July 2021 to July 2022 were continuously enrolled, and were divided into 2 groups: group of secondary intervention within 30 days (including 30 days) and group of intervention more than 30 days according to the interval between two dTRA interventions. Demographic information, history of transradial coronary intervention, time of first dTRA intervention, other comorbidities, smoking history, basic laboratory examination indicators for admission were collected. Technical indicators related to dTRA puncture and catheterization, coronary angiography and intervention, and coronary lesions were recorded. Complications like bleeding, hematoma, and compression time, radial artery pulse 24 hours after surgery were evaluated. The ultrasound of the radial artery before and 24 hours after intervention were recorded, and the diameter of the radial artery at 5cm, 10 cm and 15 cm at the proximal end of the radial styloid process was measured. Results A total of 70 patients were included in this study, including 56 males and 14 females, with an average age of 60.96�10.02 years. The median time from the previous transdistal radial intervention was 33 days. dTRA puncture were successfully conducted in 69 patients, with a success rate of 98.6%, an average number of punctures of 1.62, and an average puncture time of 3.41 minutes. The average angiography time was 8.96 minutes. The median exposure time was 1155 seconds, and the median radiation dose was 2460 mGy. One patient (1.4%) applied a 5F sheath, while 53 patients (76.8%) received a 6F sheath and 15 patients received a thin-wall domestic 7F sheath (23.8%). 6 patients (8.7%) received angiography with 6F catheter while other patients received angiography with 5F TIG catheter. PCI was successfully conducted in 66 of 67 patients, with a median PCI time of 46 minutes. One patient suffered dTRA-related complication after surgery (swelling of the hand and forearm), which was graded EASY II-III. Other patients recovered well without bleeding, hematoma, motor and sensory dysfunction of hand. All patients via dTRA access were removed compression bandage 3 hours after intervention. The radial pulse on the puncture side can be palpated immediately and 24 hours after intervention, and no abnormality was found compared with the contralateral side. Postoperative radial artery ultrasound showed no radial artery occlusion in all patients. It was indicated that the proximal, middle and distal segment of radial artery tended to be narrower in group of more than 30 days both in pre and post intervention. In group of within 30 days (including 30days), the proximal segment of radial artery was significantly narrower post intervention In group of more than 30 days, the distal segment of radial artery tended to be wider post intervention, which was statistically significant. Conclusion The study confirmed that dTRA is a safe, feasible and practical access for secondary coronary intervention. The timing of intervention (within 30 days or more) does not affect the effectiveness and safety of secondary intervention via dTRA.