Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive meta-analysis and systematic review of randomized controlled trials.
Mostafa Adel T Mahmoud, Nada G Hamam, Thoria I Essa Ghanm, Ahmed Khaled, Ahmed S A Osman, Ahmad Beddor, Islam Mohsen Elhaddad, Afnan Ismail Ibrahim
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引用次数: 0
Abstract
Background: Distal radial access (DRA) through the anatomical snuff-box is a novel technique for coronary procedures. Emerging evidence suggests that DRA is associated with a lower risk of certain complications compared to proximal radial access (PRA).
Methods: A systematic review was conducted to compare clinical and procedural outcomes between both access sites for coronary angiography and percutaneous coronary intervention. We searched PubMed, Web of Science, Cochrane, and Scopus to identify relevant randomized controlled trials.
Results: We included 23 randomized controlled trials enrolling 10 062 patients (DRA group: 5042; PRA group: 5020) in this review. DRA was associated with a lower risk for radial artery occlusion (RAO) at the longest reported follow-up [risk ratio (RR): 0.30, P < 0.00001], in-hospital RAO (RR: 0.28, P < 0.00001), any bleeding (RR: 0.40, P = 0.04), hand clumsiness (RR: 0.05, P < 0.00001), and shorter time to hemostasis [mean difference (MD): -40.93, P < 0.00001]. However, DRA showed a higher access failure rate (RR = 2.64, P < 0.00001), longer access time (MD = 0.77, P < 0.00001), more puncture attempts (MD: 0.60, P < 0.0001), and greater access-related pain [standardized mean difference (SMD) = 0.23, P = 0.02]. Both approaches were comparable in terms of major adverse cardiac events (RR = 0.74, P = 0.60), and hand function (SMD = -0.05, P = 0.68).
Conclusion: DRA is a safe alternative to PRA for coronary procedures, with a lower risk of complications, including RAO. However, it is limited by access-related challenges.
背景：桡动脉远端通道（DRA）是冠状动脉手术的一种新技术。新出现的证据表明，与近端桡骨通路（PRA）相比，DRA与某些并发症的风险较低有关。方法：系统回顾比较冠状动脉造影和经皮冠状动脉介入治疗两种通路的临床和手术结果。我们检索PubMed、Web of Science、Cochrane和Scopus以确定相关的随机对照试验。结果：我们纳入23项随机对照试验，纳入10062例患者(DRA组：5042例；PRA组：5020)。DRA与最长随访时间桡动脉闭塞（RAO）（风险比（RR）： 0.30, P < 0.00001）、院内RAO （RR: 0.28, P < 0.00001）、任何出血（RR: 0.40, P = 0.04）、手粗糙（RR: 0.05, P < 0.00001）和较短止血时间相关[平均差值（MD）： -40.93, P < 0.00001]。然而，DRA的通路失败率较高（RR = 2.64, P < 0.00001），通路时间较长（MD = 0.77, P < 0.00001），穿刺次数较多（MD: 0.60, P < 0.0001），通路相关疼痛较大[标准化平均差(SMD) = 0.23, P = 0.02]。两种方法在主要心脏不良事件（RR = 0.74, P = 0.60）和手功能（SMD = -0.05, P = 0.68）方面具有可比性。结论：DRA是一种安全的冠状动脉手术替代PRA，并发症风险较低，包括RAO。然而，它受到与访问相关的挑战的限制。
期刊介绍：
Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management.
Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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