Study on the Feasibility and Safety of Digital Subtraction Angiography through Distal Transradial Artery Access versus Transradial Approach
Objective To compare the feasibility and safety of DSA between distal transradial artery access(dTRA)and transradial approach(TRA),and to optimize the puncture approach strategy for neurointerventional therapy.Methods Patients who planned to undergo DSA in the Department of Neurology,Daxing District People's Hospital from July 2022 to January 2023 were continuously included.According to the method of generating random numbers by computer,the patients were randomly divided into the dTRA group and the TRA group.Patients who completed puncture according to the predetermined approach were included in the analysis.Demographic information,past medical history,and other baseline data of the two groups were collected.The internal diameter of puncture vessels,puncture time,puncture times,and other surgical process indexes,as well as postoperative complications such as arm pain,numbness,swelling,radial artery occlusion,and arteriovenous fistula,were compared between the two groups.A multivariate logistic regression model was used to analyze the influencing factors on the success rate of dTRA first puncture.Results In this study,320 patients who intend to undergo DSA were included,of which 306 patients were included in the data analysis,with 153 patients in the dTRA group and 153 patients in the TRA group.There was no statistical difference in baseline data between the two groups.The internal diameter of puncture vessels in the dTRA group was smaller than that in the TRA group[(1.97±0.42)mm vs.(2.23±0.44)mm,P＜0.001].There was no statistical difference in the success rate of the first puncture between the two groups.However,compared with the TRA group,the dTRA group had longer puncture time(P=0.008),more puncture times(P=0.022),longer total operation time(P=0.003),and larger radiation dose(P=0.027).Compared with the TRA group,the dTRA group had a lower postoperative pain score(P＜0.001),lower incidence of numbness and swelling(P＜0.001),and lower incidence of radial artery occlusion(P=0.002).None of the patients in the TRA group had arteriovenous fistula after the operation,and two patients in the dTRA group had arteriovenous fistula,the difference was not statistically significant.Multivariate logistic regression model analysis showed that the internal diameter of the distal radial artery(OR 3.860,95％CI 1.364-10.924,P=0.011)and the history of atrial fibrillation(OR 0.121,95％CI 0.018-0.831,P=0.032)were the risk factors affecting the success rate of dTRA first puncture.Conclusions Compared with TRA,dTRA can reduce the incidence of complications such as radial artery occlusion,numbness,swelling,and pain,and improve the comfort of patients.
Digital subtraction angiographyDistal transradial artery accessTransradial approach
万方数据
维普
