TRANSRADIAL APPROACH IN INTERVENTIONAL CARDIOLOGY: »QUOD LICET FEMORALISTI, NON LICET RADIALISTI«
Autori:
Josip Lukenda
Sažetak
Transradijalni pristup rabi se u invazivnoj kardiologiji od 1989., a od 1995. godine i za intervencije. Hrvatska kasni u toj tehnici 10-ak godina. Prednost transradijalnog pred femoralnim pristupom jesu teške lokalne komplikacije kod potonjega (2,6–2,8%), učestalije uz modernu terapiju (7,4%), koje povremeno iziskuju kiruršku korekciju (2,4%). Neželjene kardiološke komplikacije značajno su češće kod femoralnog (3,8–6,55%) nego kod transradijalnog pristupa (2,5–3,7%), a u studiji MORTAL veći je i ukupni mortalitet. Bolesnici preferiraju transradijalni pristup zbog manje boli, nelagode i mogućnosti kretanja nakon zahvata, sestre zbog upola manjeg vremena zbrinjavanja, a štedi se i 290 $ po bolesniku. Nepovoljni je aspekt klinički neznačajna okluzija radijalne arterije (0,6%–1,4%), kao i vjerojatno veće zračenje, u praksi za 12%. Trajanje zahvata je slično, iako može biti dulje do 3 minute. Promjena pristupa češća je u transradijalnim (4,7–7,6%) nego femoralnim zahvatima (1,4–2,0%), ali neuspjeh intervencije neovisan je o pristupu. Svi nepovoljni aspekti smanjuju se s iskustvom kardiologa. Neki hrvatski centri, kao OB Zadar, sada imaju udio od 67% transradijalnih koronarografija, 64% PCI i 38% primarnih PCI.
Summary
Transradial approach has been used in invasive cardiology since 1989 and since 1995 for PCI. Croatia is late in using this technique for about one whole decade. The advantage of transradial approach over femoral approach are serious local complications of (2.6–2.8%), more frequent with modern therapy (7.4%), occasionally requiring surgical repair (2.4%). Major adverse cardiovascular events are significantly more occurring with femoral (3.8–6.55%) compared to transradial approach (2.5–3.7%), while in the MORTAL study total mortality is higher as well. Patients prefer transradial approach due to it being less painful and uncomfortable, and also because of greater mobility after the procedure. Time spent for patient care by nurses is shortened by half than what it used to be, and the final savings per patient is $290. An unfavorable aspect of transradial approach is clinically insignificant radial artery occlusion (0.6%–1.4%), as well as higher radiation exposure, for 12% in practice. Procedural time is similar, but it could take up to 3 minutes longer. Access site crossover is more often with transradial (4.7–7.6%), compared to femoral procedure (1.4–2.0%), but PCI failure is independent of approach. All unfavorable aspects are diminishing with experience of a cardiologist. Now, some of the Croatian centers, such as General Hospital Zadar, use transradial approach in 67% of catheterizations, 64% of PCI, and 38% of all primary PCIs.
