Background:
Recent evidence has shown a reduced bleeding risk and resultant decreased morbidity and mortality when the transradial approach is utilized over the transfemoral approach for percutaneous coronary intervention (PCI). However, transradial catheterization may introduce acute and/or chronic injury to the radial artery limiting its use for future procedures and as a bypass conduit. Our goal was to utilize optical coherence tomography (OCT) to evaluate the incidence of acute radial artery injury in patients following transradial PCI.
Methods:
In this observational study OCT (C7 Dragonfly catheter, St. Jude Medical Systems, St. Paul, MN) was used to evaluate the radial artery of 25 patients at the University of Illinois and Jesse Brown Veterans Affairs Medical Centers in Chicago, IL following transradial PCI. Specific injuries assessed for included radial artery dissection and thrombus formation. Diameter and cross sectional area of the artery were taken proximally and distally. Measurements were taken independently by two separate readers to account for inter-reader variability.
Results:
The radial artery was assessed in 25 patients following transradial PCI. The mean BMI of our patient population was 27.8 kg/m2. A 5Fr sheath was used in 24% (n=6) cases and a 6Fr sheath was utilized for the remaining 19 cases. In 8 cases the sheath was upsized from a 5 to 6 F. The average length of artery scanned was 39.4mm with a mean proximal cross sectional area of 7.56 mm2 and distal area of 7.08 mm2. An average of 4.4 catheter exchanges were made per case. A small intimal tear was noted in the radial artery of one patient. No other dissections or thrombi were noted.
Conclusion:
Based on our initial observation, the incidence of acute radial artery injury following transradial PCI is very low (1/25) and overall transradial PCI is a safe modality. When compared with prior studies we believe the factors that decreased the incidence of acute radial artery injury in our population were related to larger arterial cross sectional area, higher mean BMI, and ultimately a lower sheath size to artery diameter ratio.
TCTAP C-136 Unexpected Complications During Transradial PCI
