经远端桡动脉入径行经皮冠状动脉介入治疗：优势、劣势、机遇和挑战

doi:10.12114/j.issn.1007-9572.2022.0874

中国全科医学 ›› 2023, Vol. 26 ›› Issue (27): 3355-3360.DOI: 10.12114/j.issn.1007-9572.2022.0874

经远端桡动脉入径行经皮冠状动脉介入治疗：优势、劣势、机遇和挑战

兰永昊¹, 科尔沁², 韩蕊¹, 梅迎晨¹, 刘巍¹^,^*()

1．100035　北京市，北京积水潭医院　北京大学第四临床医学院心内科
2．028000　内蒙古自治区呼和浩特市，内蒙古医科大学附属人民医院心内科

收稿日期:2022-10-28 修回日期:2023-03-22 出版日期:2023-09-20 发布日期:2023-04-14
通讯作者: 刘巍

【专家简介】　刘巍，北京积水潭医院心内科主任，主任医师，副教授；擅长冠心病的诊治，结构性心脏的介入治疗；在国内首先开展准分子激光治疗复杂冠心病，率先开展经皮主动脉瓣膜介入治疗。任欧洲心脏病学会委员、美国心脏病学会委员、中华医学会心血管分会冠心病与动脉粥样硬化学组委员、北京医学会心血管分会理事兼青委会副主任委员、中国医师协会心血管分会结构学组委员、北京生理学会理事。

作者贡献：兰永昊、刘巍负责论文的构思；兰永昊、科尔沁、韩蕊负责文献/资料检索与整理；兰永昊负责论文撰写及修订；科尔沁负责论文版式/格式调整；韩蕊负责翻译英文；梅迎晨负责参考文献的筛选、整理及规范；刘巍指导论文的修改，负责文章质量监督，对文章整体负责。

基金资助:
北京市自然科学基金面上项目(7232078); 北京积水潭医院青年基金(QN2019)

Percutaneous Coronary Intervention via Distal Transradial Approach: Strengths, Weaknesses, Opportunities and Challenges

LAN Yonghao¹, KE Erqin², HAN Rui¹, MEI Yingchen¹, LIU Wei¹^,^*()

1. Department of Cardiology, Beijing Jishuitan Hospital/the Fourth Clinical Medical College of Peking University, Beijing 100035, China
2. Department of Cardiology, People's Hospital of Inner Mongolia Medical University, Hohhot 028000, China

Received:2022-10-28 Revised:2023-03-22 Published:2023-09-20 Online:2023-04-14
Contact: LIU Wei

分享到

摘要/Abstract

摘要： 作为一种新的经皮冠状动脉介入治疗入径，经远端桡动脉入径近年来在临床上得到越来越广泛的应用。相较经桡动脉入径，经远端桡动脉入径在提升患者和术者舒适性、降低患者并发症发生率、减少患者前臂动脉损伤等方面具有明显优势，但也存在一定局限性，如穿刺成功率较低、学习周期较长、穿刺部位疼痛感较为明显、桡动脉痉挛发生率较高等。目前，经远端桡动脉入径亦可作为急性冠脉综合征和复杂冠状动脉经皮冠状动脉介入治疗入径，但其是否适合大规模推广、应用仍需进一步验证。本文主要总结、分析了经远端桡动脉入径行经皮冠状动脉介入治疗的优势、劣势及其面临的机遇和挑战，以期为临床科学、合理地应用经远端桡动脉入径提供参考。

关键词: 冠心病, 冠状动脉疾病, 经皮冠状动脉介入治疗, 桡动脉, 远端桡动脉, SWOT分析

Abstract:

As a new approach for percutaneous coronary intervention, distal transradial approach (dTRA) is increasingly applied in clinical practice. Thus dTRA is superior to transradial artery approach in improving patient and surgeon comfort, reducing the incidence of complications and forearm arterial injuries, while it also has many limitations, such as lower success rate, longer learning cycle, higher level of puncture site pain, and relatively higher incidence of radial artery spasm. And dTRA has also been used as an approach for acute coronary syndrome and complex percutaneous coronary intervention. But it still needs further verification whether dTRA is suitable for mass promotion and application. This paper reviews and analyzes the strengths, weaknesses, opportunities and challenges of dTRA, in order to provide a theoretical basis for scientific and rational application of dTRA in percutaneous coronary intervention.

Key words: Coronary disease, Coronary artery disease, Percutaneous coronary intervention, Radial artery, Distal radial artery, SWOT analysis

兰永昊,科尔沁,韩蕊,等. 经远端桡动脉入径行经皮冠状动脉介入治疗：优势、劣势、机遇和挑战[J]. 中国全科医学, 2023, 26(27): 3355-3360. DOI: 10.12114/j.issn.1007-9572.2022.0874.
LAN Yonghao,KE Erqin,HAN Rui, et al. Percutaneous Coronary Intervention via Distal Transradial Approach: Strengths, Weaknesses, Opportunities and Challenges[J]. Chinese General Practice, 2023, 26(27): 3355-3360. DOI: 10.12114/j.issn.1007-9572.2022.0874.

参考文献 28

[1]	KIEMENEIJ F, LAARMAN G J. Percutaneous transradial artery approach for coronary stent implantation[J]. Cathet Cardiovasc Diagn，1993，30(2):173-178. DOI：10.1002/ccd.1810300220.
[2]	NEUMANN F J, SOUSA-UVA M, AHLSSON A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J，2019，40(2):87-165. DOI：10.1093/eurheartj/ehy394.
[3]	DI SANTO P, SIMARD T, WELLS G A, et al. Transradial versus transfemoral access for percutaneous coronary intervention in ST-segment-elevation myocardial infarction：a systematic review and meta-analysis[J]. Circ Cardiovasc Interv，2021，14(3):e9994. DOI：10.1161/CIRCINTERVENTIONS.120.009994.
[4]	RASHID M, KWOK C S, PANCHOLY S, et al. Radial artery occlusion after transradial interventions：a systematic review and meta-analysis[J]. J Am Heart Assoc，2016，5(1):e002686. DOI：10.1161/JAHA.115.002686.
[5]	KIEMENEIJ F. Left distal transradial access in the anatomical snuffbox for coronary angiography（ldTRA）and interventions（ldTRI）[J]. EuroIntervention，2017，13(7):851-857. DOI：10.4244/EIJ-D-17-00079.
[6]	LEE J W, PARK S W, SON J W, et al. Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention：a prospective observational study（LeDRA）[J]. EuroIntervention，2018，14(9):e995-1003. DOI：10.4244/EIJ-D-18-00635.
[7]	KIM Y, AHN Y, KIM I, et al. Feasibility of coronary angiography and percutaneous coronary intervention via left snuffbox approach[J]. Korean Circ J，2018，48(12):1120-1130. DOI：10.4070/kcj.2018.0181.
[8]	VALSECCHI O, VASSILEVA A, CEREDA A F, et al. Early clinical experience with right and left distal transradial access in the anatomical snuffbox in 52 consecutive patients[J]. J Invasive Cardiol，2018，30(6):218-223.
[9]	ZIAKAS A, KOUTOUZIS M, DIDAGELOS M, et al. Right arm distal transradial（snuffbox）access for coronary catheterization：initial experience[J]. Hellenic J Cardiol，2020，61(2):106-109. DOI：10.1016/j.hjc.2018.10.008.
[10]	KOUTOUZIS M, KONTOPODIS E, TASSOPOULOS A, et al. Distal versus traditional radial approach for coronary angiography[J]. Cardiovasc Revasc Med，2019，20(8):678-680. DOI：10.1016/j.carrev.2018.09.018.
[11]	SOYDAN E, AKIN M. Coronary angiography using the left distal radial approach-an alternative site to conventional radial coronary angiography[J]. Anatol J Cardiol，2018，19(4):243-248. DOI：10.14744/AnatolJCardiol.2018.59932.
[12]	LATSIOS G, TOUTOUZAS K, SYNETOS A, et al. Left distal radial artery for cardiac catheterization：insights from our first experience[J]. Hellenic J Cardiol，2018，59(6):352-353. DOI：10.1016/j.hjc.2017.12.004.
[13]	ISATH A, ELSON D, KAYANI W, et al. A meta-analysis of traditional radial access and distal radial access in transradial access for percutaneous coronary procedures[J]. Cardiovas Revasc Med，2023，46:21-26. DOI：10.1016/j.carrev.2022.09.006.
[14]	COOMES E A, HAGHBAYAN H, CHEEMA A N. Distal transradial access for cardiac catheterization：a systematic scoping review[J]. Catheter Cardiovasc Interv，2020，96(7):1381-1389. DOI：10.1002/ccd.28623.
[15]	TSIGKAS G, PAPAGEORGIOU A, MOULIAS A, et al. Distal or traditional transradial access site for coronary procedures：a single-center，randomized study[J]. JACC Cardiovasc Interv，2022，15(1):22-32. DOI：10.1016/j.jcin.2021.09.037.
[16]	MIZUGUCHI Y, IZUMIKAWA T, HASHIMOTO S, et al. Efficacy and safety of the distal transradial approach in coronary angiography and percutaneous coronary intervention：a Japanese multicenter experience[J]. Cardiovasc Interv Ther，2020，35(2):162-167. DOI：10.1007/s12928-019-00590-0.
[17]	EID-LIDT G, RODRÍGUEZ A R, CASTELLANOS J J, et al. Distal radial artery approach to prevent radial artery occlusion trial[J]. JACC Cardiovasc Interv，2021，14(4):378-385. DOI：10.1016/j.jcin.2020.10.013.
[18]	ROGHANI-DEHKORDI F, HASHEMIFARD O, SADEGHI M, et al. Distal accesses in the hand（two novel techniques）for percutaneous coronary angiography and intervention[J]. ARYA Atheroscler，2018，14(2):95-100. DOI：10.22122/arya.v14i2.1743.
[19]	NAITO T, SAWAOKA T, SASAKI K, et al. Evaluation of the diameter of the distal radial artery at the anatomical snuff box using ultrasound in Japanese patients[J]. Cardiovasc Interv Ther，2019，34(4):312-316. DOI：10.1007/s12928-018-00567-5.
[20]	SHINOZAKI N, IKARI Y. Distal radial artery approach for endovascular therapy[J]. Cardiovasc Interv Ther，2022，37(3):533-537. DOI：10.1007/s12928-021-00801-7.
[21]	KIM Y, AHN Y, KIM M C, et al. Gender differences in the distal radial artery diameter for the snuffbox approach[J]. Cardiol J，2018，25(5):639-641. DOI：10.5603/CJ.2018.0128.
[22]	AMINIAN A, SGUEGLIA G A, WIEMER M, et al. Distal versus conventional radial access for coronary angiography and intervention：the DISCO RADIAL trial[J]. JACC Cardiovasc Interv，2022，15(12):1191-1201. DOI：10.1016/j.jcin.2022.04.032.
[23]	徐奕，杨跃进. 经远端桡动脉入径行经皮冠状动脉介入治疗的研究进展[J]. 中国介入心脏病学杂志，2020，28(5):277-279. DOI：10.3969/j.issn.1004-8812.2020.05.008.
[24]	GRAGNANO F, BRANCA M, FRIGOLI E, et al. Access-site crossover in patients with acute coronary syndrome undergoing invasive management[J]. JACC Cardiovasc Interv，2021，14(4):361-373. DOI：10.1016/j.jcin.2020.11.042.
[25]	THAKOR A S, ALSHAMMARI M T, LIU D M, et al. Transradial access for interventional radiology：single-centre procedural and clinical outcome analysis[J]. Can Assoc Radiol J，2017，68(3):318-327. DOI：10.1016/j.carj.2016.09.003.
[26]	PACHA H M, ALAHDAB F, AL-KHADRA Y, et al. Ultrasound-guided versus palpation-guided radial artery catheterization in adult population：a systematic review and meta-analysis of randomized controlled trials[J]. Am Heart J，2018，204:1-8. DOI：10.1016/j.ahj.2018.06.007.
[27]	TANG L, WANG F, LI Y, et al. Ultrasound guidance for radial artery catheterization：an updated meta-analysis of randomized controlled trials[J]. PLoS One，2014，9(11):e111527. DOI：10.1371/journal.pone.0111527.
[28]	HADJIVASSILIOU A, KIEMENEIJ F, NATHAN S, et al. Ultrasound-guided access to the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions：a technical guide[J]. EuroIntervention，2021，16(16):1342-1348. DOI：10.4244/EIJ-D-19-00555.

经远端桡动脉入径行经皮冠状动脉介入治疗：优势、劣势、机遇和挑战

Percutaneous Coronary Intervention via Distal Transradial Approach: Strengths, Weaknesses, Opportunities and Challenges

RichHTML

PDF

PDF (英文版)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 28

相关文章 15

编辑推荐

Metrics

留言

[1]	张迪, 李鸿鹏, 马江, 聂谦, 孙剑峰, 吴志鹏, 张宏才, 赵珏. 眼针带针运动对经皮冠状动脉介入术治疗患者术后心率变异性及预后的影响研究[J]. 中国全科医学, 2023, 26(36): 4535-4544.
[2]	王秋实, 李虹伟. CHA₂DS₂-VASc卒中风险评分对冠心病三支血管或左主干病变患者主要不良心血管事件的预测价值研究[J]. 中国全科医学, 2023, 26(33): 4130-4136.
[3]	王珍, 申国旗, 李亚南, 朱英华, 仇航, 郑迪, 徐通达, 李文华. 急性心肌梗死患者行经皮冠状动脉介入治疗术后发生对比剂急性肾损伤风险预测模型的建立与验证研究[J]. 中国全科医学, 2023, 26(29): 3650-3656.
[4]	高扬, 王贇霞, 张优, 高传玉. ≤45岁急性冠脉综合征患者中超高危冠状动脉粥样硬化性心脏病人群降脂治疗后血脂达标率及影响因素研究[J]. 中国全科医学, 2023, 26(27): 3383-3387.
[5]	袁铭培, 林耀望, 贝伟杰, 刘华东, 董少红, 孙鑫. 经远端桡动脉入径逆向开通闭塞桡动脉的可行性：单中心前瞻性研究[J]. 中国全科医学, 2023, 26(27): 3373-3377.
[6]	蔡高军, 师干伟, 李峰, 李文华, 严永敏, 薛社亮, 肖建强, 顾君, 宋艳斌, 张刘燕, 卢伟, 龚春. 如何提高经远端桡动脉入径穿刺成功率、"曲径通幽"？基于两千余病例的经验总结[J]. 中国全科医学, 2023, 26(27): 3361-3365.
[7]	刘明浩, 王攀, 高立建, 徐淑清, 王欢欢, 赵光贤, 陈珏, 乔树宾, 徐波, 袁晋青. 经远端桡动脉入径行二次经皮冠状动脉介入治疗的可行性、安全性和手术时机研究[J]. 中国全科医学, 2023, 26(27): 3366-3372.
[8]	陆彬, 项崇, 袁雪松, 蔡高军, 魏文锋, 严永敏. 经远端桡动脉入径在脑血管造影中的有效性、安全性及满意度研究[J]. 中国全科医学, 2023, 26(27): 3378-3382.
[9]	闫海浩, 张飞飞, 党懿. 残余胆固醇与急性冠脉综合征患者易损斑块特征的相关性研究[J]. 中国全科医学, 2023, 26(26): 3303-3307.
[10]	祖姆热提·阿布都克依木, 马燕玲, 朱凯瑞, 刘芳, 李霞. 早期生长反应因子3和白介素6水平与冠状动脉粥样硬化性心脏病的相关性研究[J]. 中国全科医学, 2023, 26(24): 3016-3021.
[11]	陈焱, 吕智博, 赵昕. 残粒脂蛋白胆固醇及非高密度脂蛋白胆固醇水平不一致性与冠状动脉狭窄严重程度的相关性研究[J]. 中国全科医学, 2023, 26(24): 3010-3015.
[12]	王丹, 王建辉, 董建秀, 常文红, 秦璐, 刘琪, 陈晨. 基于网络干预对经皮冠状动脉介入治疗术后患者运动行为的影响研究[J]. 中国全科医学, 2023, 26(21): 2603-2608.
[13]	刘晶涛, 苏荷, 秦小金, 兰云霞, 张金枝. 冠心病患者心脏康复相关指南的系统评价[J]. 中国全科医学, 2023, 26(19): 2323-2331.
[14]	陈轶琳, 林平, 韩永奎, 王旖旎. 经皮冠状动脉介入治疗患者Ⅰ期心脏康复依从性及影响因素模型的构建研究[J]. 中国全科医学, 2023, 26(18): 2209-2216.
[15]	高扬, 王贇霞, 高传玉. ≤45岁急性冠脉综合征患者可能家族性高胆固醇血症的临床特点及血脂达标影响因素研究[J]. 中国全科医学, 2023, 26(18): 2232-2237.