Feasibility of Retrograde Recanalization of Occluded Radial Artery via Distal Transradial Artery Approach: a Single-center Prospective Study

doi:10.12114/j.issn.1007-9572.2022.0869

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (27): 3373-3377.DOI: 10.12114/j.issn.1007-9572.2022.0869

• Monographic Research • Previous Articles Next Articles

Feasibility of Retrograde Recanalization of Occluded Radial Artery via Distal Transradial Artery Approach: a Single-center Prospective Study

1. Department of Cardiology, Shenzhen People's Hospital/the Second Clinical Medical College of Jinan University/the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen 518020, China
2. Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen 518020, China

Received:2022-12-13 Revised:2023-03-23 Published:2023-09-20 Online:2023-04-14
Contact: SUN Xin

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

1．518020　广东省深圳市人民医院　暨南大学第二临床医学院　南方科技大学第一附属医院心血管内科
2．518020　广东省深圳市，心血管微创医学工程技术研发中心

通讯作者: 孙鑫

作者简介:

【专家简介】　孙鑫，深圳市人民医院副主任医师，医学博士，硕士生导师；从事心血管疾病医疗、教学和科研工作，并致力于理、工、医多学科交叉和转化研究；擅长心血管急重症的诊治及冠状动脉介入诊疗；广东省医师协会心脏重症分会血流动力学与重症超声专业组副组长；广东省医师协会心内科分会委员；广东省医学会心血管分会青年委员，大拇指远端桡动脉俱乐部秘书；深圳市高层次人才，深圳市卫生健康菁英人才，深圳市优青；主持国家自然科学基金青年项目、面上项目等9项；发表SCI收录文章35篇，其中作为第一作者/通信作者16篇；授权国家发明及实用新型专利5项；获得省科学技术一等奖等4项；Journal of Geriatric Cardiology青年编委，中华心血管病学杂志（网络版）通讯编委。

作者贡献：袁铭培负责研究的可行性分析、文献检索、统计学分析及论文撰写；林耀望、贝伟杰、刘华东、董少红进行数据收集与整理，负责患者随访；林耀望进行论文修订，负责文章质量控制及审校；孙鑫提出研究构思并制订整体研究目标，对文章整体负责。

基金资助:
深圳市医学重点学科建设经费资助(SZXK003); 深圳市医疗卫生三名工程项目(SZSM201412012)

Abstract

Abstract:

Background

The incidence of radial artery occlusion (RAO) after coronary intervention via transradial artery approach (TRA) is high. But there is a lack of long-term follow-up studies with a large sample size on retrograde recanalization of occluded radial artery via distal transradial artery approach (dTRA) .

Objective

To assess the feasibility of dTRA for retrograde recanalization of occluded radial artery.

Methods

Forty-four patients undergoing retrograde recanalization via dTRA for treating RAO after coronary intervention via TRA were consecutively recruited from Shenzhen People's Hospital from June 2019 to December 2021. The primary observation index was postprocedural radial artery patency. And secondary observation index included possible predictors of failed retrograde recanalization, incidence of adverse events during hospitalization, and patency rates of radial artery at 3, 6 and 12 months after procedure.

Results

The success rate of postprocedural radial artery patency was 88.6% (39/44) , and divided into groups of successful (n=39) and failed (n=5) according to the result of the procedure. Compared with the successful group, the failed group had higher percentages of diabetics, current smokers and chronic total occlusion of the coronary artery, as well as a significantly lower prevalence of undergoing balloon angioplasty (P<0.05) . There was significant intergroup difference in the times of coronary interventions (P<0.05) ; there was no significant intergroup difference in the incidence of bleeding or hematoma at the access site during hospitalization (P>0.05) . The patency rates of radial artery in successful group were 48.7% (19/39) , 43.6% (17/39) , and 35.9% (14/39) at 3, 6, and 12 months after procedure, respectively.

Conclusion

The dTRA may be feasible for retrograde recanalization of occluded radial artery, which showed a high procedural success rate up to 88.6%, but the long-term patency rate was less than 50.0%. Diabetes, smoking, times of coronary interventions, chronic total occlusion of coronary artery, and receiving no balloon angioplasty may be influencing factors of failed retrograde recanalization of occluded radial artery via dTRA. And dTRA for retrograde recanalization of occluded radial artery is recommended for patients with RAO who also require elective coronary intervention.

Key words: Coronary disease, Coronary artery disease, Percutaneous coronary intervention, Coronary angiography, Arterial occlusive diseases, Distal radial artery, Radial artery occlusion, Prospective studies, Feasibility studies

摘要：

背景

经桡动脉入径行冠状动脉介入诊疗后桡动脉闭塞（RAO）发生率较高，但目前尚缺少关于经远端桡动脉入径（dTRA）逆向开通闭塞桡动脉的大样本量、长期随访研究。

目的

评估dTRA逆向开通闭塞桡动脉的可行性。

方法

连续纳入深圳市人民医院心血管内科2019年6月—2021年12月收治的TRA行冠状动脉介入诊疗后出现RAO的患者44例。主要观察指标为dTRA逆向开通闭塞桡动脉成功率，次要观察指标包括dTRA逆向开通闭塞桡动脉失败的可能预测因素、住院期间并发症发生情况及术后3、6、12个月桡动脉通畅率。

结果

本研究dTRA逆向开通闭塞桡动脉成功率为88.6%（39/44），根据dTRA逆向开通闭塞桡动脉情况分为成功组（n=39）与失败组（n=5）。失败组患者糖尿病病史、吸烟、慢性冠状动脉完全闭塞比例高于成功组，行球囊成形术比例低于成功组（P<0.05）。两组患者既往行冠状动脉介入诊疗次数比较，差异有统计学意义（P<0.05）；两组患者住院期间穿刺部位出血、血肿发生率比较，差异无统计学意义（P>0.05）。成功组患者术后3、6、12个月桡动脉通畅率分别为48.7%（19/39）、43.6%（17/39）、35.9%（14/39）。

结论

dTRA逆向开通闭塞桡动脉具有可行性，成功率高达88.6%，但远期通畅率低于50.0%；糖尿病、吸烟、既往行冠状动脉介入诊疗次数、慢性冠状动脉完全闭塞、未行球囊成形术可能是dTRA逆向开通闭塞桡动脉失败的影响因素；推荐RAO同时需择期行冠状动脉介入诊疗的患者dTRA逆向开通闭塞桡动脉。

关键词: 冠心病, 冠状动脉疾病, 经皮冠状动脉介入治疗, 冠状血管造影术, 动脉闭塞性疾病, 远端桡动脉, 桡动脉闭塞, 前瞻性研究, 可行性研究

YUAN Mingpei,LIN Yaowang,BEI Weijie, et al. Feasibility of Retrograde Recanalization of Occluded Radial Artery via Distal Transradial Artery Approach: a Single-center Prospective Study[J]. Chinese General Practice, 2023, 26(27): 3373-3377. DOI: 10.12114/j.issn.1007-9572.2022.0869.
袁铭培,林耀望,贝伟杰等. 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. DOI: 10.12114/j.issn.1007-9572.2022.0869.

Figures/Tables 3

References 19

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组别	例数	年龄（±s，岁）	性别〔例（%）〕		BMI （±s，kg/m²）	术中收缩压（±s，mmHg）	术中心率（±s，次/min）	高血压病史〔例（%）〕	糖尿病病史〔例（%）〕	吸烟〔例（%）〕
组别	例数	年龄（±s，岁）	男性	女性	BMI （±s，kg/m²）	术中收缩压（±s，mmHg）	术中心率（±s，次/min）	高血压病史〔例（%）〕	糖尿病病史〔例（%）〕	吸烟〔例（%）〕
成功组	39	58.3±12.7	25（64.1）	14（35.9）	24.7±3.4	132±22	67±15	24（61.5）	13（33.3）	13（33.3）
失败组	5	66.0±11.9	3（60.0）	2（40.0）	25.5±3.3	127±23	81±18	3（60.0）	4（80.0）	4（80.0）
χ²（t）值		-1.290^a	0.147		-0.494^a	-0.451^a	1.646^a	0.004	3.978	3.978
P值		0.228	0.986		0.635	0.660	0.108	0.948	0.046	0.046
组别	既往行冠状动脉介入诊疗次数〔例（%）〕			慢性冠状动脉完全闭塞〔例（%）〕	估算肾小球滤过率〔±s，mL·min^-1·（1.73 m²）^-1〕	左心室射血分数（±s，%）	诊断〔例（%）〕			治疗方案〔例（%）〕
组别	1次	2次	≥3次	慢性冠状动脉完全闭塞〔例（%）〕	估算肾小球滤过率〔±s，mL·min^-1·（1.73 m²）^-1〕	左心室射血分数（±s，%）	急性ST段抬高型心肌梗死	急性非ST段抬高型心肌梗死-急性冠脉综合征	稳定性冠状动脉疾病	双联抗血小板治疗	抗凝治疗
成功组	30（76.9）	4（10.3）	5（12.8）	20（51.3）	76.67±18.32	52.80±3.56	8（20.5）	6（15.4）	25（64.1）	37（94.9）	2（5.1）
失败组	1（20.0）	1（20.0）	3（60.0）	5（100.0）	75.28±31.60	53.16±13.18	3（60.0）	0	2（40.0）	5（100.0）	0
χ²（t）值	7.834			6.891	-0.096^a	0.136^a	0.453			0.108
P值	0.020			0.041	0.890	0.893	0.137			0.743

组别	例数	年龄（±s，岁）	性别〔例（%）〕		BMI （±s，kg/m²）	术中收缩压（±s，mmHg）	术中心率（±s，次/min）	高血压病史〔例（%）〕	糖尿病病史〔例（%）〕	吸烟〔例（%）〕
组别	例数	年龄（±s，岁）	男性	女性	BMI （±s，kg/m²）	术中收缩压（±s，mmHg）	术中心率（±s，次/min）	高血压病史〔例（%）〕	糖尿病病史〔例（%）〕	吸烟〔例（%）〕
成功组	39	58.3±12.7	25（64.1）	14（35.9）	24.7±3.4	132±22	67±15	24（61.5）	13（33.3）	13（33.3）
失败组	5	66.0±11.9	3（60.0）	2（40.0）	25.5±3.3	127±23	81±18	3（60.0）	4（80.0）	4（80.0）
χ²（t）值		-1.290^a	0.147		-0.494^a	-0.451^a	1.646^a	0.004	3.978	3.978
P值		0.228	0.986		0.635	0.660	0.108	0.948	0.046	0.046
组别	既往行冠状动脉介入诊疗次数〔例（%）〕			慢性冠状动脉完全闭塞〔例（%）〕	估算肾小球滤过率〔±s，mL·min^-1·（1.73 m²）^-1〕	左心室射血分数（±s，%）	诊断〔例（%）〕			治疗方案〔例（%）〕
组别	1次	2次	≥3次	慢性冠状动脉完全闭塞〔例（%）〕	估算肾小球滤过率〔±s，mL·min^-1·（1.73 m²）^-1〕	左心室射血分数（±s，%）	急性ST段抬高型心肌梗死	急性非ST段抬高型心肌梗死-急性冠脉综合征	稳定性冠状动脉疾病	双联抗血小板治疗	抗凝治疗
成功组	30（76.9）	4（10.3）	5（12.8）	20（51.3）	76.67±18.32	52.80±3.56	8（20.5）	6（15.4）	25（64.1）	37（94.9）	2（5.1）
失败组	1（20.0）	1（20.0）	3（60.0）	5（100.0）	75.28±31.60	53.16±13.18	3（60.0）	0	2（40.0）	5（100.0）	0
χ²（t）值	7.834			6.891	-0.096^a	0.136^a	0.453			0.108
P值	0.020			0.041	0.890	0.893	0.137			0.743

组别	例数	手术时间（±s，min）	所用辅助导丝〔例（%）〕		使用球囊辅助〔例（%）〕	介入治疗类型〔例（%）〕		总手术费用（±s，元）
组别	例数	手术时间（±s，min）	0.014″	0.025″	使用球囊辅助〔例（%）〕	血栓抽吸术	球囊成形术	总手术费用（±s，元）
成功组	39	43.8±9.4	22（56.4）	20（51.3）	35（89.7）	17（43.6）	37（94.9）	2 352.8±87.2
失败组	5	50.4±5.8	5（100.0）	4（80.0）	5（100.0）	0	0	2 317.0±115.1
χ²（t）值		-1.451^a	20.230	18.940	24.430	10.320^b	26.730^b	-1.430^a
P值		0.064	0.052	0.230	0.458	0.067	<0.001	0.768

组别	例数	手术时间（±s，min）	所用辅助导丝〔例（%）〕		使用球囊辅助〔例（%）〕	介入治疗类型〔例（%）〕		总手术费用（±s，元）
组别	例数	手术时间（±s，min）	0.014″	0.025″	使用球囊辅助〔例（%）〕	血栓抽吸术	球囊成形术	总手术费用（±s，元）
成功组	39	43.8±9.4	22（56.4）	20（51.3）	35（89.7）	17（43.6）	37（94.9）	2 352.8±87.2
失败组	5	50.4±5.8	5（100.0）	4（80.0）	5（100.0）	0	0	2 317.0±115.1
χ²（t）值		-1.451^a	20.230	18.940	24.430	10.320^b	26.730^b	-1.430^a
P值		0.064	0.052	0.230	0.458	0.067	<0.001	0.768

Feasibility of Retrograde Recanalization of Occluded Radial Artery via Distal Transradial Artery Approach: a Single-center Prospective Study

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

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