Percutaneous Coronary Intervention By Transradial And Distal Transradial Access In The Anatomical Snuffbox Approaches:A Comparison Study

Objective: To explore the feasibility and safety of the Coronary Angiography(CAG)and percutaneous coronary intervention(PCI)via the distal radial artery at the anatomical snuffbox.Methods:316 patients were selected in our study who underwent CAG and PCI at The Second Affiliated Hospital of Zhejiang Chinese Medical University from October 2017 to August 2018.150 patients in the observation group who underwent CAG and PCI in the radial artery through the distal radial artery access,and 150 patients in the control group who underwent CAG and PCI through the radial artery were included in the control group,and 16 patients were excluded.Two groups were observed in basic information,number and time of puncture,patients with operation success rate,postoperative compression time,the NRS scores at 3 hours after operation,hospitalization time,complications,operation time,use of contrast agent,X-ray exposure time.Results: The mean age of the patients in the observation group was 66.71±10.53 years,including 94 males(62.7%).On average,the number of puncture attempts was 1.46±0.72,the puncture time was 2.27±2.20 minutes,the postoperative compression time was 3.28±0.82 hours,the NRS scores at 3 hours after operation was 1.48±0.65,the mean hospitalization time was 7.05±4.97 days.The mean age of the patients in the control group was 68.10±11.27 years,including 78 males(58%).On average,the number of puncture attempts was 1.33±0.77,the puncture time was 1.98±1.99 minutes,the postoperative compression time was 4.56±1.17 hours,the NRS scores at 3 hours after operation was 1.9±0.81,the mean hospitalization time was 7.39±4.41 days.There were 8 cases of local hematoma after operation and 4 cases of radial artery spasm in the observation group.There were 5 cases of local hematoma and 3 cases of radial artery spasm in the control group.There were no cases of radial artery occlusion,arteriovenous fistula and dysfunction of the hand and arm in the two groups.The diameter of the right radial distal artery is 0.170±0.045 cm.And the diameter of the right radial artery is 0.217±0.056 cm.There was a significant correlation between the internal diameter of the radial artery and the diameter of the radial artery in the bilateral snuff pockets(left: r=0.637 0.522,p<0.05;right r=0.522,p<0.05).There were no significant differences in the basic information,time of puncture,patients with operation success rate,operation time,use of contrast agent,Xray exposure time,and hospitalization time between the two groups(P>0.05).There were significant differences in the number of punctures,the NRS scores at 3 hours after operation,and postoperative compression time(P<0.05).Conclusion: Cardiac catheterization through the distal radial artery in the snuffbox is safe and feasible.The right distal radial artery access can be routinely carried out.It has great value in clinical application.