Khảo sát biến chứng của tiếp cận động mạch quay xa trong chụp và can thiệp động mạch vành qua da
Nội dung chính của bài viết
Tóm tắt
Bệnh mạch vành là gánh nặng sức khỏe lớn trên toàn cầu. Tiếp cận động mạch quay xa trong can thiệp mạch vành được xem là một cải tiến với khả năng giảm nguy cơ biến chứng. Dù đã có dữ liệu tích cực từ nhiều quốc gia, tại Việt Nam hiện còn thiếu bằng chứng về tính an toàn của cách tiếp cận này. Do đó, chúng tôi tiến hành nghiên cứu cắt ngang mô tả, thu nhận tất cả những bệnh nhân thỏa tiêu chuẩn chọn mẫu tại khoa Tim mạch can thiệp, Bệnh viện Đại học Y Dược TP. HCM, từ tháng 11/2023 đến tháng 06/2024. Trong 158 bệnh nhân, tỉ lệ các biến chứng của tiếp cận động mạch quay xa là: đau theo thang điểm VAS: VAS 1 điểm chiếm 25%; VAS 2 điểm chiếm 11%; VAS 4 điểm chiếm 0,6%. Không có trường hợp điểm VAS > 4 điểm. Chảy máu theo phân độ EASY: Độ 1 chiếm 1,3%; độ 2 chiếm 1,9%; độ 3 chiếm 0,6%. Tắc động mạch quay 4,4% (7/158). Như vậy, tiếp cận động mạch quay xa là lựa chọn an toàn trong chụp, can thiệp mạch vành qua da.
Chi tiết bài viết
Từ khóa
Can thiệp mạch vành qua da, động mạch quay xa, an toàn, biến chứng
Tài liệu tham khảo
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2. Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. JACC. 0(0). doi:10.1016/j.jacc.2025.08.015.
3. Gargiulo G, Giacoppo D, Jolly SS, et al. Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized Clinical Trials. Circulation. 2022; 146(18): 1329-1343. doi:10.1161/CIRCULATIONAHA.122.061527.
4. Bernat I, Aminian A, Pancholy S, et al. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper. JACC Cardiovasc Interv. 2019; 12(22): 2235-2246. doi:10.1016/j.jcin.2019.07.043.
5. Sgueglia GA, Lee BK, Cho BR, et al. Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv. 2021; 14(8): 892-906. doi:10.1016/j.jcin.2021.02.033.
6. Korotkikh A, Babunashvili A, Kaledin A, et al. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol. 2023; 48(4): 101546. doi:10.1016/j.cpcardiol.2022.101546.
7. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415-3537. doi:10.1093/eurheartj/ehae177.
8. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025; 151(13): e771-e862. doi:10.1161/CIR.0000000000001309.
9. Silva RL da, Moreira DM, Fattah T, et al. Pain assessment during transradial catheterization using the Visual Analogue Scale. Revista Brasileira de Cardiologia Invasiva (English Edition). 2015; 23(3): 207-210. doi:10.1016/j.rbciev.2015.08.007.
10. Shroff A, Siddiqui S, Burg A, Singla I. Identification and management of complications of transradial procedures. Curr Cardiol Rep. 2013; 15(4): 350. doi:10.1007/s11886-013-0350-x.
11. Koutouzis M, Kontopodis E, Tassopoulos A, et al. Distal Versus Traditional Radial Approach for Coronary Angiography. Cardiovasc Revasc Med. 2019; 20(8): 678-680. doi:10.1016/j.carrev.2018.09.018.
12. Aminian A, Sgueglia GA, Wiemer M, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022; 15(12): 1191-1201. doi:10.1016/j.jcin.2022.04.032.
13. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.
14. Kim Y, Ahn Y, Kim I, et al. Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach. Korean Circ J. 2018; 48(12): 1120-1130. doi:10.4070/kcj.2018.0181.
15. Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017; 13(7): 851-857. doi:10.4244/EIJ-D-17-00079.
16. Al-Azizi KM, Grewal V, Gobeil K, et al. The Left Distal Transradial Artery Access for Coronary Angiography and Intervention: A US Experience. Cardiovasc Revasc Med. 2019; 20(9): 786-789. doi:10.1016/j.carrev.2018.10.023.
17. Lee JW, Kim Y, Lee BK, et al. Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial. JACC Cardiovasc Interv. 2024; 17(3): 329-340. doi:10.1016/j.jcin.2023.11.021.
18. Chen T, Li L, Li F, et al. Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial. BMC Med. 2024; 22(1): 62. doi:10.1186/s12916-024-03281-7.
19. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC: Cardiovascular Interventions. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.
2. Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. JACC. 0(0). doi:10.1016/j.jacc.2025.08.015.
3. Gargiulo G, Giacoppo D, Jolly SS, et al. Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized Clinical Trials. Circulation. 2022; 146(18): 1329-1343. doi:10.1161/CIRCULATIONAHA.122.061527.
4. Bernat I, Aminian A, Pancholy S, et al. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper. JACC Cardiovasc Interv. 2019; 12(22): 2235-2246. doi:10.1016/j.jcin.2019.07.043.
5. Sgueglia GA, Lee BK, Cho BR, et al. Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv. 2021; 14(8): 892-906. doi:10.1016/j.jcin.2021.02.033.
6. Korotkikh A, Babunashvili A, Kaledin A, et al. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol. 2023; 48(4): 101546. doi:10.1016/j.cpcardiol.2022.101546.
7. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415-3537. doi:10.1093/eurheartj/ehae177.
8. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025; 151(13): e771-e862. doi:10.1161/CIR.0000000000001309.
9. Silva RL da, Moreira DM, Fattah T, et al. Pain assessment during transradial catheterization using the Visual Analogue Scale. Revista Brasileira de Cardiologia Invasiva (English Edition). 2015; 23(3): 207-210. doi:10.1016/j.rbciev.2015.08.007.
10. Shroff A, Siddiqui S, Burg A, Singla I. Identification and management of complications of transradial procedures. Curr Cardiol Rep. 2013; 15(4): 350. doi:10.1007/s11886-013-0350-x.
11. Koutouzis M, Kontopodis E, Tassopoulos A, et al. Distal Versus Traditional Radial Approach for Coronary Angiography. Cardiovasc Revasc Med. 2019; 20(8): 678-680. doi:10.1016/j.carrev.2018.09.018.
12. Aminian A, Sgueglia GA, Wiemer M, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022; 15(12): 1191-1201. doi:10.1016/j.jcin.2022.04.032.
13. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.
14. Kim Y, Ahn Y, Kim I, et al. Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach. Korean Circ J. 2018; 48(12): 1120-1130. doi:10.4070/kcj.2018.0181.
15. Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017; 13(7): 851-857. doi:10.4244/EIJ-D-17-00079.
16. Al-Azizi KM, Grewal V, Gobeil K, et al. The Left Distal Transradial Artery Access for Coronary Angiography and Intervention: A US Experience. Cardiovasc Revasc Med. 2019; 20(9): 786-789. doi:10.1016/j.carrev.2018.10.023.
17. Lee JW, Kim Y, Lee BK, et al. Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial. JACC Cardiovasc Interv. 2024; 17(3): 329-340. doi:10.1016/j.jcin.2023.11.021.
18. Chen T, Li L, Li F, et al. Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial. BMC Med. 2024; 22(1): 62. doi:10.1186/s12916-024-03281-7.
19. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC: Cardiovascular Interventions. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.