ÖZET
Amaç:
Transradiyal yaklaşım (TRY) koroner girişimlerde yaygın olarak kullanılmaktadır. TRY ile kanama, hematom ve psödoanevrizma gibi komplikasyon oranları azaltılmaktadır. Bu çalışmanın amacı anti-agreganların ve düşük moleküler ağırlıklı heparinin (DMAH) tedavideki rolünü ortaya koymaktır.
Yöntemler:
Toplam 239 olgu [140 erkek, (%58,6)] dahil edildi. Olguların 159’u (%66,5) elektifti ve 80’inde (%33,5) akut koroner sendrom vardı. Radiyal arter oklüzyonu (RAO) saptanan hastalar 2 hafta DMAH ile tedavi edildi.
Bulgular:
Hastaların 23’ünde (%9,6) RAO gözlendi. RAO gelişen 23 olgudan 12’si (%52,8) anti-agregan kullanıyordu, 11’i (%47,8) kullanmıyordu (p<0,001). Anti-agregan kullanan grupta, DMAH tedavisi sonrası radial akımda sadece DMAH tedavisine kıyasla istatistiksel olarak anlamlı bir iyileşme gözlendi (p<0,001).
Sonuç:
Bu çalışmada anti-agreganların anti-koagülanlara eklenmesinin RAO oranını ve, semptomlarını azalttığını ve ayrıca anti-koagülanların etkilerini güçlendirdiğini ve RAO’da daha yüksek rekanalizasyon oranı ile sonuçlandığını gösterdik.
References
1
Hildick-Smith DJ, Lowe MD, Walsh JT, Ludman PF, Stephens NG, Schofield PM, et al. Coronary angiography from the radial artery-experience, complications and limitations. Int J Cardiol 1998;64:231-9.
2
Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004;44:349-56.
3
Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, et al, Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol 2014;64:1554-64.
4
Aoun J, Hattar L, Dgayli K, Wong G, Bhat T. Update on complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther 2019;17:741-51.
5
Shroff A, Siddiqui S, Burg A, Singla I. Identification and management of complications of transradial procedures. Curr Cardiol Rep 2013;15:350.
6
Wagener JF, Rao SV. Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 2015;17:489.
7
Kotowycz MA, Dzavik V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv 2012;5:127-33.
8
Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, et al. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography: The SPIRIT OF ARTEMIS Study. JACC Cardiovasc Interv 2018;11:2241-50.
9
Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, et al. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016;5:e002686.
10
Degirmencioglu A, Buturak A, Zencirci E, Karakus G, Güvenc TS, Akyol A, et al. Comparison of Effects of Low- versus High-Dose Heparin on Access-Site Complications during Transradial Coronary Angiography: A Double-Blind Randomized Study. Cardiology 2015;131:142-8.
11
Pacchioni A, Bellamoli M, Mugnolo A, Ferro J, Pesarini G, Turri R, et al. Predictors of patent and occlusive hemostasis after transradial coronary procedures. Catheter Cardiovasc Interv 2021;97:1369-76.
12
Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 2008;72:335-40.
13
Uhlemann M, Möbius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M, et al. The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. JACC Cardiovasc Interv 2012;5:36-43.
14
Erdem K, Kurtoğlu E, Küçük MA, İlgenli TF, Kızmaz M. Distal transradial versus conventional transradial access in acute coronary syndrome. Turk Kardiyol Dern Ars 2021;49:257-65.
15
Hahalis G, Aznaouridis K, Tsigkas G, Davlouros P, Xanthopoulou I, Koutsogiannis N, et al. Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-AnalysIS) Systematic Review and Meta-Analysis. J Am Heart Assoc 2017;23;6:e005430.
16
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. “2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267-315.
17
Spaulding C, Lefèvre T, Funck F, Thébault B, Chauveau M, Ben Hamda K, et al. Left radial approach for coronary angiography: results of a prospective study. Cathet Cardiovasc Diagn 1996;39:365-70.
18
Dahal K, Sharma S, Yousuf A, Lee J, Azrin M, Jimenez E, et al. A comparison of standard versus low dose heparin on access-related complications after coronary angiography through radial access: A meta-analysis of randomized controlled trials. Cardiovasc Revasc Med 2018;19:575-9.
19
Geschwind JF, Dagli MS, Lambert DL, Kobeiter H. Thrombolytic therapy in the setting of arterial line-induced ischemia. J Endovasc Ther. J Endovasc Ther 2003;10:590-4.
20
Steinmetz M, Radecke T, Boss T, Stumpf MJ, Lortz J, Nickenig G, et al. Radial artery occlusion after cardiac catheterization and impact of medical treatment. Vasa 2020;49:463-6.
21
Zankl AR, Andrassy M, Volz C, Ivandic B, Krumsdorf U, Katus HA, et al. Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins. Clin Res Cardiol 2010;99:841-7.
22
Bernat I, Bertrand OF, Rokyta R, et al. Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol. 2011;107:1698–701.
23
Roy S, Choxi R, Wasilewski M, Jovin IS. Novel oral anticoagulants in the treatment of radial artery occlusion Catheter Cardiovasc Interv 2021;98:1133-7.
24
Rammos C, Burghardt A, Lortz J, Azizy O, Jánosi RA, Steinmetz M, et al. Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: A case-control study. Eur J Med Res 2018;23:25.
