Читать книгу Interventional Cardiology - Группа авторов - Страница 71

Due to its superficial course distally and relative freedom from other anatomical structures, the radial artery is easy to puncture and safe to compress after sheath removal [2]. Bleeding complications are easily recognized by the patient or clinician and readily controlled by local compression. As a result, TRA has proven efficacy in reducing non‐ischemic complications of percutaneous coronary intervention (PCI), namely those involving vascular access site and bleeding. Multiple randomized control trials (RCTs) and meta‐analyses have shaped recent international guidelines that are now unanimous in support of radial access as the default approach for patients undergoing coronary angiography and percutaneous intervention (unless there are overriding procedural considerations) [3–5].

A meta‐analysis of randomized trials incorporating 22 000 patients demonstrated that compared to transfemoral access (TFA), TRA was associated with a significantly lower risk of all‐cause mortality (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.59 to 0.87; p = 0.001, number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR, 0.84; 95% CI, 0.75 to 0.94; p = 0.002; NNTB = 99), major bleeding (OR, 0.53; 95% CI, 0.42 to 0.65; p < 0.001; NNTB = 103), and major vascular complications (OR, 0.23; 95% CI, 0.16 to 0.35; p < 0.001; NNTB = 117) [1]. Furthermore, TRA is associated with even greater benefits in ACS patients [4,6,7]. Pooled analysis of this higher risk cohort suggests over 25% reduction in 30‐day mortality with TRA compared to TFA (1.7% v 2.4%; OR, 0.72; 95% CI, 0.58 to 0.88) [8].

There are important potential disadvantages of TRA for the operator including a longer fluoroscopy time and higher radiation dose. RAD‐Matrix determined that TRA was associated with a significantly higher patient and operator radiation exposure due to higher fluoroscopy time (10 min vs 9 min; p < 0.0001) and higher dose area product (65 Gycm² vs 59Gycm²; p = 0.0001) [11].