Intravascular Ultrasound Assessment of Distal Trans-Radial Access in Patients Undergoing Percutaneous Coronary Intervention.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Enrico Poletti, Giuseppe Colletti, Carlo Zivelonghi, Alice Benedetti, Alice Moroni, Hicham El Jattari, Alexandre Natalis, Francesca Rubino, Benjamin Scott, Elias Bentakhou, Steven E F Haine, Pierfrancesco Agostoni, Claudiu Ungureanu
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引用次数: 0

Abstract

Background: Distal trans-radial access (dTRA) for percutaneous coronary interventions (PCI) is increasingly gaining attention due to its potential to mitigate radial artery occlusion (RAO). However, a comprehensive understanding of the mechanical impact of the devices on the radial artery (RA) wall remains limited. Using a complete intravascular ultrasound (IVUS) evaluation of the RA, including also the vascular access site, we aimed to evaluate all the consequences related to the catheterization on the RA wall, starting from the vascular access, comparing conventional sheath and sheathless approaches.

Methods: This is an observational, prospective, multicenter study aimed to assess the entire RA wall immediately after IVUS-guided PCI via-dTRA. IVUS assessment included quantitative measurements (minimal lumen area [MLA], minimal vessel area [MVA]) and qualitative observations (dissections, vasospasm). Study objectives included delineating RA wall structure post-PCI and comparing findings between conventional and sheathless approaches.

Results: Fifty patients (21 [42%] with conventional sheath, 29 [58%] sheathless) were enrolled between March 2023 and February 2024. Female patients were more prevalent in the convention sheath group (38% vs. 7%, p < 0.001). Sheathless approach utilized 7-French guiding catheters more frequently (33% vs. 86%, p < 0.001). Post-procedural IVUS identified dissections in 12% of cases, with no significant difference between approaches. Arterial vasospasm was present in a quarter of patients, numerically higher in the conventional sheath group (29% vs. 21%, p = 0.5). MLA and MVA were comparable between groups, though MLA and MVA were lowest at the proximal segment of the RA only in the conventional sheath group (p < 0.001). No RAO was documented during the IVUS evaluation.

Conclusions: The intravascular assessment of dTRA after coronary interventions, utilizing either conventional or sheathless approaches, including large-bore guiding catheters, demonstrated a relatively low incidence of access-related complications such as dissection and vasospasm, without affecting the flow and patency of the proximal RA.

血管内超声评估经皮冠状动脉介入治疗患者的远端经导管入路情况。
背景:用于经皮冠状动脉介入治疗(PCI)的经桡动脉远端入路(dTRA)因其可减轻桡动脉闭塞(RAO)而日益受到关注。然而,人们对该装置对桡动脉(RA)壁的机械影响的全面了解仍然有限。通过对 RA(包括血管通路部位)进行全面的血管内超声(IVUS)评估,我们旨在从血管通路入手,评估导管插入对 RA 壁造成的所有影响,并对传统鞘式和无鞘式方法进行比较:这是一项观察性、前瞻性、多中心研究,目的是在 IVUS 引导下通过 dTRA 进行 PCI 后立即评估整个 RA 壁。IVUS 评估包括定量测量(最小管腔面积 [MLA]、最小血管面积 [MVA])和定性观察(断裂、血管痉挛)。研究目标包括描绘PCI后的RA壁结构,并比较传统方法和无鞘方法的结果:2023年3月至2024年2月期间,50名患者(21人[42%]使用传统鞘,29人[58%]使用无鞘)被纳入研究。常规鞘组中女性患者较多(38% 对 7%,P 结论:常规鞘组中女性患者较多(38% 对 7%,P 结论:无鞘组中女性患者较少):使用传统或无鞘方法(包括大口径导引导管)进行冠状动脉介入治疗后,对 dTRA 进行血管内评估,结果表明介入相关并发症(如夹层和血管痉挛)的发生率相对较低,且不会影响近端 RA 的血流和通畅性。
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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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