Size Matters: Moving Toward a Slender Transradial Artery Approach.
Size Matters: Moving Toward a Slender Transradial Artery Approach.
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尺寸很重要：走向细长的经桡动脉入路。
DOI：
10.1016/j.carrev.2018.06.012
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Shah,Binita
中科院分区：
文献类型：
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作者：
Villablanca,Pedro;Shah,Binita
在具有高风险TRA失败特征的患者中使用VAA是等式的另一个重要组成部分。我们的小组进行了一项单中心随机试验，以评价动脉穿刺部位（左侧vs.右侧TRA）对具有TRA失败预测因子（以下4项标准中的≥ 3项：年龄≥ 70岁，女性，身高≤ 64英寸，高血压）的患者的辐射参数的影响。在本研究中，超过90%的入组患者为身材矮小的女性，使用左侧TRA时，放射参数在数值上较低，但在统计学上不较低[12]。但是，在这些经TRA完成手术失败风险高的患者中，没有关于最佳Fr尺寸的结论性数据。如果一方面，一些操作者更喜欢5 Fr系统，以最大限度地减少痉挛的风险并增加克服外周迂曲的可能性，那么6 Fr系统在PCI期间广泛用于更大范围的器械和技术选择。在本期心血管再血管化医学中，Sgueglia等人介绍了一个单中心，一项前瞻性观察性研究[13]，评价了身材矮小女性的两种不同TRA方法（身高< 160厘米）：完整的6 Fr工作流程（6 Fr导引鞘、诊断导管和导引导管）与使用6 Fr导引鞘、5 Fr诊断导管、6 Fr导引导管。在研究中评估的120名患者中，52.5%接受了6 Fr工作流程，47.5%接受了修改后的工作流程。作者发现桡动脉痉挛的发生率显著降低（25% vs. 43%，p= 0.03），需要转换为另一种入路（2% vs. 11%，p= 0.04），入路相关疼痛也较低（3.8±2.3 vs. 4.9±2.2，p= 0.04）。尽管X线透视时间无显著差异（14±6 min vs. 13±5 min，p= 0.36），但与6 Fr工作流程相比，使用改良工作流程通过病变的手术时间显著缩短（17±7 min vs. 22±11 min，p= 0.01）。作者得出结论，在身材矮小的女性（TRA失败可能性较高的患者）中应考虑使用5 Fr而不是6 Fr诊断导管策略。
V AA uthor Man uscript be used in patients with features of high-risk TRA failure is another important component of the equation. Our group performed a single-center randomized trial to evaluate the effect of arterial access site (left vs. right TRA) on radiation parameters in patients with predictors of TRA failure (≥ 3 of 4 following criteria: age≥ 70 years, female sex, height≤ 64 inches, hypertension). In this study, more than 90% of patients enrolled were women with short stature, and parameters of radiation were numerically but not statistically lower with the use of left TRA [12]. No conclusive data, though, are available on the optimal Fr size in these patients at high risk of failure to complete procedures via TRA. If on one hand, some operators prefer a 5 Fr system to minimize the risk of spasm and increase the likelihood of overcoming peripheral tortuosity, 6 Fr systems are widely used for the use of a larger selection of devices and techniques during PCI.In this issue of Cardiovascular Revascularization Medicine, Sgueglia et al. present a single center, prospective observational study [13] evaluating two different approaches to TRA in short-stature women (< 160 cm height): A full 6 Fr workflow (6 Fr introducer sheath, diagnostic catheters, and guiding catheter) versus a modified workflow that uses a 6 Fr introducer sheath, 5 Fr diagnostic catheters, 6 Fr guiding catheter. Of the 120 patients evaluated in the study, 52.5% underwent a 6 Fr workflow and 47.5% underwent a modified workflow. The authors found a significantly lower rate of radial artery spasm (25% vs. 43%, p= 0.03) and need to switch to another access (2% vs. 11%, p= 0.04), as well as lower access related pain (3.8±2.3 vs. 4.9±2.2, p= 0.04). Although there was no significant difference in fluoroscopy time (14±6 min vs. 13±5 min, p= 0.36), there was a significantly lower procedure time (17±7 min vs. 22±11 min, p= 0.01) to lesion crossing with the modified workflow compared to the 6 Fr workflow. The authors concluded that a 5 Fr, as opposed to 6 Fr, diagnostic catheter strategy should be considered in women with short stature (patients with higher likelihood of TRA failure).