PDF(Pubmed)
Abstract：
Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single-center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA. The primary end point of change in hand function from baseline to 30 days was a composite of the QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire, hand-grip test, and thumb forefinger pinch test. Secondary end points included access feasibility and complications; 254 of 300 patients completed follow-up at 30 days; of these, 128 were randomized to dRA and 126 to pRA with balanced demographic and procedural characteristics. Both groups had similar rates of access site bleeding (dRA 0% versus pRA 1.4%; P=0.25). Six patients with dRA failed access compared with 2 patients with pRA. Radial artery occlusion occurred in 2 pRA versus none in dRA. There were no significant differences in change in hand function, median hand-grip (dRA 0 [-3.2, 3.3] versus pRA 0.7 [-2.3, 3.3] kg; P=0.21), pinch-grip (dRA -0.3 [-1.2, 0.5] versus pRA 0 [-0.9, 0.9] kg; P=0.09), and QuickDASH (dRA 0 [-4.6, 2.3] versus pRA 0 [-4.6, 2.3] points, P=0.96). There was no significant difference in the composite of hand function between pRA and dRA. Conclusions dRA is a safe strategy for cardiac catheterization with a low complication rate. Compared with pRA, there is no increased risk of hand dysfunction at 30 days. Registration URL: https://www.ClinicalTrials.gov. Unique identifier: NCT04318990.
摘要：
背景技术用于心导管插入的桡动脉近端(pRA)通路是安全的,但是由于闭塞而可能危及动脉的后续使用。解剖鼻烟盒中的桡动脉远端（dRA）通道保留了桡动脉，但对手部功能的安全性和潜在有害影响尚不清楚。方法和结果在DIPRA（远端与近端桡动脉介入治疗）研究中，单中心试验,300例患者通过dRA或pRA以1：1的比例随机分配至心导管插入术。从基线到30天手功能变化的主要终点是QuickDASH（手臂快速残疾，肩和手)问卷，手握测试,和拇指食指捏测试。次要终点包括通路可行性和并发症；300例患者中有254例在30天完成随访；其中，128例随机分配至dRA，126例随机分配至pRA，具有平衡的人口统计学和程序特征。两组的通路部位出血率相似(dRA0%对pRA1.4%;P=0.25)。6例dRA患者未能获得治疗，而2例pRA患者未能获得治疗。2pRA中发生radial动脉闭塞，dRA中没有。在手功能的改变上没有显著差异,中位握力（dRA0[-3.2，3.3]对pRA0.7[-2.3，3.3]kg；P=0.21），捏夹(dRA-0.3[-1.2,0.5]对pRA0[-0.9,0.9]kg;P=0.09),和QuickDASH（dRA0[-4.6，2.3]对pRA0[-4.6，2.3]点，P=0.96）。pRA和dRA之间手功能的复合没有显着差异。结论dRA是一种安全的心导管插入策略，并发症发生率低。与pRA相比,30天时手部功能障碍的风险没有增加.注册网址：https://www。ClinicalTrials.gov.唯一标识符：NCT04318990。
