蔡梦阳,夏晴,章慧慧,袁红

• 1:杭州市临平区第一人民医院心内科

摘要(Abstract)：

近年来冠心病的发病率呈逐年上升趋势，经皮冠状动脉介入治疗是冠心病的有效治疗方法之一，而桡动脉是其传统的血管路径。舒适化医疗医学时代，经远端桡动脉路径（dTRA）是一种用于冠状动脉造影和经皮冠状动脉介入治疗的新手术路径，其具有局部并发症少，患者舒适度高等优点，正在逐渐替代传统桡动脉路径（TRA）。然而，作为近两年新兴的技术，dTRA也存在一些缺点，如血管扭曲、直径小等，可能导致穿刺失败、血管痉挛、导丝送入困难等不良事件。本文就dTRA行冠状动脉介入诊疗的应用价值及进展作一综述，以促进其在临床诊疗中推广，进而使更多患者获益。

关键词(KeyWords)： 冠心病;冠状动脉造影;经皮冠状动脉介入治疗;远端桡动脉

Abstract:

Keywords:

基金项目(Foundation): 浙江省中医药科技计划项目（2024ZL832）;; 临平区科技计划项目（LPWJ2023-02-05）

作者(Author): 蔡梦阳,夏晴,章慧慧,袁红

参考文献(References)：

• [1] Neumann FJ,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.
• [2]《经远端桡动脉行冠状动脉介入诊疗中国专家共识》专家组,大拇指俱乐部.经远端桡动脉行冠状动脉介入诊疗中国专家共识[J].中国介入心脏病学杂志,2020,28(12):667-674.DOI:10.3969/j.issn.1004-8812.2020.12.002.
• [3]Feng C,Zong B,Liu Y,et al.Comparison of distal transradial approach versus conventional transradial approach for coronary angiography and percutaneous coronary intervention:A prospective observational study[J].Heliyon,2023,9(6):e17150.DOI:10.1016/j.heliyon.2023.e17150.
• [4]Achim A,Kákonyi K,Jambrik Z,et al.Distal radial artery access for recanalization of radial artery occlusion and repeat intervention:a single center experience[J].J Clin Med,2022,11(23):6916.DOI:10.3390/jcm11236916.
• [5]Kiemeneij F.Left distal transradial access in the anatomical snuffbox for coronary angiography(1dTRA)and interventions(IdTRI)[J].EuroIntervention,2017,13(7):851-857.DOI:10.4244/EIJ-D-17-00079.
• [6]Lee JW,Kim Y,Lee BK,et al.Distal radial access for coronary procedures in a large prospective multicenter registry:the KODRA trial[J].JACC Cardiovasc Interv,2024,17(3):329-340.DOI:10.1016/j.jcin.2023.11.021.
• [7]Chen T,Li L,Li F,et al.Comparison of long-term radial artery occlusion via distal vs.conventional transradial access(CONDITION):a randomized controlled trial[J].BMC Med,2024,22(1):62.DOI:10.1186/s12916-024-03281-7.
• [8]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.
• [9]Eid-Lidt G,Rivera Rodriguez A,Jimenez Castellanos,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.j cin.2020.10.013.
• [10]李峰,肖建强,蔡高军.经远端桡动脉路径行冠状动脉介入诊疗的发展历程及研究进展[J].中国全科医学,202 1,24(6):748-752.DOI:10.12114/j.issn.1007-9572.2020.00.523.
• [11]Corcos T.Distal radial access for coronary angiography and percutaneous coronary intervention:a state-of-the-art review[J].Catheter Cardiovasc Interv,2019,93(4):639-644.DOI:10.1002/ccd.28016.
• [12]Lee JW,Park SW,Son JW,et al.Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention:a prospective observational study(LeDRA)[J],Euro Intervention,2018,14(9):e995-e1003.DOI:10.4244/EIJ-D-18-00635.
• [13]Lin Y,Sun X,Chen R,et al.Feasibility and safety of the distal transradial artery for coronary diagnostic or interventional catheterization[J].J Interv Cardiol,2020,2020:4794838.DOI:10.1155/2020/4794838.
• [14]Yamada T,Washimi S,Hashimoto S,et al.Feasibility and safety of the successive use of distal transradialaccess for coronary angiography and intervention in the same arm[J].Catheter Cardiovasc Interv,2021,98(6):E796-E801.DOI:10.1002/ccd.29938.
• [15]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.
• [16]Aminian A,Sgueglia GA,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.j cin.2022.04.032.
• [17]辛丽娜,谢莲娜,魏显敬,等.经远端桡动脉行冠状动脉介入诊疗术后桡动脉闭塞的发生率[J].中国介入心脏病学杂志,2022,30(6):430-434.DOI:10.3969/j.issn.1004-8812.2022.06.007.
• [18]Feghaly J,Chen K,Blanco A,et al.Distal versus conventional radial artery access for coronary catheterization:a systematic review and meta-analysis[J].Catheter Cardiovasc Interv,2023,101(4):722-736.DOI:10.1002/ccd.30602.
• [19]Rob JW,Kim Y,Takahata M,et al.Optimal hemostasis duration for percutaneous coronary intervention via the snuffbox approach:a prospective,multi-center,observational study(HEMOBOX)[J].Int J Cardiol,2021,338:79-82.DOI:10.1016/j.ijcard.2021.06.035.
• [20]Sgueglia GA,Hassan A,Harb S,et al.International hand function study following distal radial access:the RATATOUELLE study[J].JACC Cardiovasc Intern,2022,15(12):1205-1215.DOI:10.1016/j.j cin.2022.04.023.
• [21]A1-Azizi K,Moubarak G,Dib C,et al.Distal versus proximal radial artery access for cardiac catheterization:30-day outcomes of the DIPRA study[J].J Am Heart Assoc,2023,12(21):e030774.DOI:10.1161/JAHA.123.030774.
• [22]Al-Azizi K,Moubarak G,Dib C,et al.Distal versus proximal radial artery access for cardiac catheterization:1-year outcomes[J].Am J Cardiol,2024,220:102-110.DOI:10.1016/j.amjcard.2024.02.036.
• [23]Tehrani BN,Sherwood MW,Damluji AA,et al.A randomized comparison of radial artery intimal hyperplasia following distal versus proximal transradial access for coronary angiography:PRESERVE RADIAL[J].J Am Heart Assoc,2024,13(4):e031504.DOI:10.1161/JAHA.123.031504.
• [24]Sgueglia GA,Lee BK,Cho BR,et al.Distal radial access:consensus report of the first korea-europe transradial intervention meeting[J].JACC Cardiovasc Interv,2021,14(8):892-906.DOI:10.1016/j.j cin.2021.02.033.
• [25]Liontou C,Kontopodis E,Oikonomidis N,et al.Distal radial access:a review article[J].Cardiovasc Revasc Med,2020,21(3):412-416.DOI:10.1016/j.carrev.2019.06.003.
• [26]Mhanna M,Beran A,Nazir S,et al.Outcomes of distal versus conventional transradial access for coronary angiography and intervention:an updated systematic review and metaanalysis[J].Int J Cardiol,2021,344:47-53.DOI:10.1016/j.ijcard.2021.10.003.
• [27]Vefali V,Sangam E.The comparison of traditional radial access and novel distal radial access for cardiac catheterization[J].Cardiovasc Revasc Med,2020,21(4):496-500.DOI:10.1016/j.carrev.2019.07.001
• [28]Nairoukh Z,Jahangir S,Adjepong D,et al.Distal radialartery access:the future of cardiovascular intervention[J].Cureus,2020,12(3):e7201.DOI:10.7759/cureus.7201.
• [29]Li W,Wang J,Liang X,et al.Comparison of the feasibility and safety between distal transradial access and conventional transradial access in patients with acute chest pain:a singlecenter cohort study using propensity score matching[J].BMC Geriatr,2023,23(1):348.DOI:10.1186/s12877-023-04058-y.
• [30]Kili?R,Güzel T,Aktan A,et al.Comparison of pain levels of traditional radial,distal radial,and transfemoral coronary catheterization[J].Rev Assoc Med Bras(1992),2023,69(7):e20230198.DOI:10.1590/1806-9282.20230198.
• [31] Achim A,Peter OA,Kakonyi K,et al.The role of ultrasound in accessing the distal radial artery at the anatomical snuffbox for cardiovascular interventions[J].Life(Basel),2022,13(1):25.DOI:10.3390/life13010025.
• [32]Maitra S,Ray BR,Bhattacharjee S,et al.Distal radial arterial cannulation in adult patients:a retrospective cohort study[J].Saudi J Anaesth,2019,13(1):60-62.DOI:10.4103/sja.SJA 700 18.
• [33]Mori S,Hirano K,Yamawaki M,et al.A comparative analysis between ultrasound-guided and conventional distal transradial access for coronary angiography and intervention[J].J Interv Cardiol,2020,2020:7342732.DOI:10.1155/2020/7342732.
• [34]Shi G,Li F,Zhang L,et al.Retrograde recanalization of occluded radial artery:a single-centre experience and literature review[J].J Endovasc Ther,2022,29(5):755-762.DOI:10.1177/15266028211067732.
• [35]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.
• [36]Hahalis G,Aznaouridis K,Tsigkas G,et al.Radial artery and ulnar artery occlusions following coronary procedures and the impact of anticoagulation:ARTEMIS(Radial and Ulnar ARTEry Occlusion Meta-AnalysIS)systematic review and metaanalysis[J].J Am Heart Assoc,2017,6(8):e005430.DOI:10.1161/JAHA.116.005430.
• [37]Shah SR,Kiemeneij F,Khuddus MA.Distal arteriovenous fistula formation after percutaneous coronary intervention:an old complication of a new access site[J].Catheter Cardiovasc Interv,2021,97(2):278-281.DOI:10.1002/ccd.28772.
• [38]Budassi S,Zivelonghi C,De Roover D,et al.Distal radial pseudoaneurysm after chronic total occlusion percutaneous coronary intervention resolved by percutaneous thrombin inj ection[7].Cardiovasc Revasc Med,2020,21(11S):134-137.DOI:10.1016/j.carrev.2020.05.01B.
• [39]Achim A,Kakonyi K,Nagy F,et al.Radial artery calcification in predicting coronary calcification and atherosclerosis burden[J].Cardiol Res Pract,2022,2022:5108389.DOI:10.115 5/2022/5108389.
• [40] Rashid M,Kwok CS,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.
• [41]Balaban Y,Elevli MG.It is both possible and safe to perform coronary angiography through the same radial artery,afterretrograde recanalization of radial artery occlusion,following a previous coronary angiography[J].J Interv Cardiol,2018,31(6):957-963.DOI:10.1111/joic.12524.
• [42]Maleux G,Vander Mijnsbrugge W,Henroteaux D,et al.Multicenter,randomized trial of conventional balloon angioplasty versus paclitaxel-coated balloon angioplasty for the treatment of dysfunctioning autologous dialysis fistulae[J].J Vasc Interv Radiol,2018,29(4):470-475.e3.DOI:10.1016/j.jvir.2017.10.023.
• [43]Lin Y,Bei W,Liu H,et al.Retrograde recanalization of radial artery occlusion via the distal transradial artery:a singlecenter experience[J].Front Cardiovasc Med,2022,9:985092.DOI:10.3389/fcvm.2022.985092.
• [44]Kim Y,Lee JW,Lee SY,et al.Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with ST-elevation myocardial infarction[J].Korean J Intern Med,2021,36(Suppl 1):S53-S61.DOI:10.3904/kjim.2019.420.
• [45]Byrne RA,Rossello X,Coughlan JJ,et al.2023 ESC Guidelines for the management of acute coronary syndromes[J].Eur Heart J,2023,44(38):3720-3826.DOI:10.1093/eurheartj/ehad191.
• [46]Li F,Shi GW,Yu XL,et al.Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox:a single-centre prospective cohort study using a propensity score method[J].BMC Cardiovasc Disord,2022,22(1):74.DOI:10.1186/s12872-022-02518-8.
• [47]Rao SV,Ou FS,Wang TY,et al.Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention:a report from the National Cardiovascular Data Registry[J].JACC Cardiovasc Interv,2008,1(4):379-386.DOI:10.1016/j.jcin.2008.05.007.
• [48]Feldman DN,Swaminathan RV,Kaltenbach LA,et al.Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention:an updated report from the national cardiovascular data registry(2007-20 12)[J].Circulation,20 1 3,127(23):2295-2306.DOI:10.1161/CIRCULATIONAHA.112.000536.
• [49]Shima Y,Kubo S,Ikuta A,et al.Feasibility and safety of coronary catheterization with the distal radial approach for hemodialysis patients[J].J Cardiol,2022,80(2):162-166.DOI:10.1016/j.jjcc.2022.02.014.
• [50]Yokota S,Shishido K,Tobita K,et al.Distal transradial access for cardiac catheterization in patients undergoing hemodialysis[J].J Invasive Cardiol,2022,34(8):E627-E632.