Feasibility And Safety Of Percutaneous Coronary Intervention Via Distal Radial Artery Approach

Background: Cardiovascular disease is the most common cause of death in china,ranking first among the causes of death in the chinese population,and it is known as “the first killer of human health”.The morbidity and mortality of cardiovascular diseases are increasing year by year and tend to be younger.Coronary heart disease(CHD)is the most common type of cardiovascular disease,including chronic ischemic syndrome(CIS)and acute coronary syndrome(ACS).At present,clinical treatments for CHD include drug therapy,interventional therapy and coronary artery bypass graft(CABG).With the gradual maturity and continuous development of medical technology,percutaneous coronary intervention(PCI)is widely used in the clinical treatment of CHD because of its advantages such as small trauma,reliable efficacy,low mortality and rapid postoperative recovery.At the moment,the frequently used pathways of PCI mainly include the forearm radial artery approach and the femoral artery approach.In recent years,interventional pathway of the distal radial artery through the “snuff box” has gradually been applied to clinical use as a new approach,however there is still a lack of large-scale clinical studies at home and abroad to confirm its feasibility and safety.Therefore,it is of great clinical value to explore the feasibility and safety of PCI through the distal radial artery in the “snuff box”.Objective: This study is designed to investigate the feasibility and safety of PCI in the distal radial artery,thus providing a new,safe and effective PCI intervention approach for patients with CHD.Methods: Both 150 patients with CHD admitted for treatment in our hospital were enrolled from June 2018 to January 2019.In accordance to the random number table,they were randomly divided into the forearm radial artery group(control group)and the distal radial artery group(study group)with 75 patients in each group.The control group underwent PCI via radial artery of the forearm and the study group underwent PCI via distal radial artery of the “snuff box”.All these 150 patients with CHD were measured with color doppler ultrasound diagnostic instrument prior to operation on the inner diameter of bilateral forearm radial artery,distal radial artery and cardiac ejection fraction.The clinical basic data,surgery related indicators and incident rate of intraoperative and post operative complications of the two groups were recorded.Results: Color doppler ultrasound showed that the inner diameter of the right distal radial artery(2.344±0.405)mm was smaller than the inner diameter of the right forearm radial artery(2.502±0.446)mm and the inner diameter of the left distal radial artery(2.353±0.398)mm was smaller than the inner diameter of the left forearm radial artery(2.499±0.443)mm in all patients,with statistical difference(P<0.05).However,the diameter of distal radial artery in some patients is still greater than or equal to the outer diameter of 6.5F thin-walled sheath.The average puncture time(7.299±1.117)min in the distal radial artery group was higher than that in the forearm radial artery group(5.252±1.259)min,and the difference was statistically significant(P<0.05).The compression hemostasis time(6.197±0.714)h in the distal radial artery group was lower than that in the forearm radial artery group(6.628±0.650)h,the difference was statistically significant(P<0.05).There was no significant difference in success rate of first puncture,operation success rate and postoperative hospitalization time between the two groups(P>0.05).The incidence of complications,such as arm pain(1.33% VS 10.67%),arm swelling(0% VS 9.33%)and radial artery occlusion(0% VS 8.00%)in the distal radial artery group,was lower than that in the forearm radial artery group,with statistically significant difference(P<0.05).There was no statistically significant difference in the incidence of radial artery spasm and local hematoma between the two groups(P>0.05).Conclusion: The inner diameter of the distal radial artery is smaller than that of the forearm radial artery,but it is safe and feasible for the most majority of people to use APT 6.5F thin-walled sheath for PCI through the distal radial artery.Compared with PCI via forearm radial artery,PCI via distal radial artery is also safe and effective,which can reduce the incidence of intraoperative and postoperative complications and make postoperative clinical nursing more convenient.