P6371Endothelial functions are preserved in left distal radial access coronary angiography, a prospective comparison with right and left forearm radial artery access site

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.

Download Full-text

Abstract 17406: Early Experience With Ultrasound Guided Distal Trans-Radial Access in the Anatomical Snuffbox in Coronary Angiography and Intervention

Circulation ◽

10.1161/circ.138.suppl_1.17406 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Sangyeub Lee ◽

Woong-su Yoon ◽

Daehwan Bae ◽

Min Kim ◽

Sang Min Kim ◽

...

Keyword(s):

Coronary Angiography ◽

Success Rate ◽

Radial Artery ◽

Early Experience ◽

Coronary Intervention ◽

Ultra Sound ◽

Potential Candidate ◽

Ultrasound Guided ◽

Radial Approach ◽

Radial Access

Early experience with ultrasound guided distal trans-radial access in the anatomical snuffbox in coronary angiography and intervention. Objective: We aimed to demonstrate the feasibility and safety of the ultrasound guided distal trans-radial coronary angiography and intervention. Methods: Patients assigned to one operator program underwent diagnostic or procedural intervention through distal trans-radial approach in the anatomical snuffbox between January 2018 and May 2018. All of patients had palpable artery in their distal radial artery. The operator did the coronary procedure via distal radial access at anatomical snuffbox. When the pulse was weak or the target artery was very small, the operator punctured under ultrasound guidance (V-scan with dual probe, GE heathcare, USA) Results: 56 patients were enrolled. Mean age of patients was 65.1 years old and 68% were male. About 70% of patients were presented with stable angina feature. In diagnostic procedure, 4F (3, 5.6%) or 5F (29, 54.7%) sheath was used and we did coronary intervention via 6F (21, 39.6%) Sheath. Ultrasound guided puncture was done for 33 patients (58.9%). Overall Success rate of distal trans-radial angiography and intervention was 94.6% (3 failed cases). Success rate of ultrasound guided procedure was 97% (only 1 failed case). Left distal radial puncture was done for 18 patients (33.9%). 16% of patients had chronic kidney disease, especially end stage renal disease (11%) to preserve radial artery which was potential candidate of arteriovenous fistulae for dialysis. There was no BARC type 2-5 bleeding in hospital stay and follow up at out-patient clinic. Conclusion: Ultra sound guided distal radial approach is feasible and safe as a good alternative technique for coronary angiography and interventions.

Download Full-text

Abstract 374: Trans-radial Access Angiography Learning Curve

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.374 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Julian Chan ◽

Rosanna Tavella ◽

John F Beltrame ◽

Matthew Worthley ◽

Sivabaskari Pasupathy ◽

...

Keyword(s):

Coronary Angiography ◽

Learning Curve ◽

Radial Artery ◽

Vascular Access ◽

Best Practice ◽

Femoral Access ◽

Coronary Syndrome ◽

Radial Access ◽

Increased Risk ◽

Radial Operators

Introduction: Radial artery access has been adopted widely around the world as standard best practice for coronary angiography with or without percutaneous coronary intervention. Radial artery access offers benefits in regard to reduced major bleeding, reduced hospital stay, fewer vascular complications, similar procedural times, patient preference and a mortality benefit in acute coronary syndrome/STEMI management. Despite transradial access being best practice, there has been a slow uptake of this technique amongst some cardiologists/interventionalists, particularly in the USA. This may partially be attributed to uncertainties regarding the learning curve and concerns regarding delaying treatment in STEMI if radial access fails. Methods: Using the data from the Coronary Angiography Database Of South Australia registry (CADOSA), we sought to determine the radial access failure rates for acute cases during transition from routine femoral access to routine radial access from 2012 to 2016, a period when the greatest transition in practice occurred. Data regarding initial vascular access, success or failure, and subsequent vascular access was prospectively recorded for all cases. Operators with at least a 70% rate of initial radial access were deemed to be established radial operators and acted as controls for operators transitioning from femoral access (at least 70% of cases) to radial access during the study period. Cases were further classified as elective, urgent (eg inpatient ACS) or emergency (eg STEMI). Results: There were 23 operators with sufficient volumes, responsible for 20,073 cath lab visits during the 5 year period studied. The overall radial access rate increased from 57% in 2012 to 78% in 2016. For operators transitioning from a default femoral access (76% of case) to a default radial access (75% of cases), the radial access failure rate for urgent and emergency cases was 3.7%, compared to 3.5% for experienced radial operators over the same period. Conclusion: Despite strong evidence of benefit for radial access angiography and intervention, compared to femoral access, some operators remain reluctant to transition. Utilising the CADOSA database, we observed a safe transition from femoral to radial access without an increased risk of access site failure for acute cases. Transition from femoral to radial access can be made safely by a range of clinicians managing acute cases.

Download Full-text

P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

European Heart Journal ◽

10.1093/eurheartj/ehz746.1113 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Ognerubov ◽

A Tereshchenko ◽

E Merkulov ◽

S Provatorov ◽

G Arutyunyan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Angiography ◽

Radial Artery ◽

Stable Coronary Artery Disease ◽

Ulnar Artery ◽

Coronary Intervention ◽

Artery Occlusion ◽

Careful Examination ◽

Radial Access ◽

Short Time

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

Download Full-text

Should the radial artery be used as a bypass graft following radial access coronary angiography: Table 1:

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt478 ◽

2013 ◽

Vol 18 (2) ◽

pp. 219-224 ◽

Cited By ~ 11

Author(s):

Lisa M. Lim ◽

Sean D. Galvin ◽

Mohamed Javid ◽

George Matalanis

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Bypass Graft ◽

Radial Access

Download Full-text

Evaluation of radial artery endothelial functions in transradial coronary angiography according to different radial access sites.

The Anatolian Journal of Cardiology ◽

10.14744/anatoljcardiol.2020.59085 ◽

2020 ◽

Author(s):

Elton Soydan

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Radial Access ◽

Endothelial Functions

Download Full-text

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.2385 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Ruzsa ◽

N Sandor ◽

J Toth ◽

M Deak ◽

B Zafirovska ◽

...

Keyword(s):

Radial Artery ◽

Subclavian Artery ◽

Artery Occlusion ◽

Access Site ◽

Total Occlusion ◽

Access Site Complication ◽

Radial Access ◽

Angiographic Data ◽

Procedural Complications ◽

Radial Artery Occlusion

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p<0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p<0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p<0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p<0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p<0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

Download Full-text

Outcome off Primary Coronary Angioplasty by Radial Route: Study on 100 Cases

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/06 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr. Dilip Ratnani ◽

Dr. Rekha Ratnani

Keyword(s):

Hospital Stay ◽

Radial Artery ◽

Bleeding Complications ◽

Access Site ◽

Transfemoral Approach ◽

Artery Cannulation ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Radial Access ◽

Coronary Procedures

Recently radial artery is being used as a vascular access route for coronary procedures. Primary angioplasty with transfemoral procedure is associated with high access site bleeding complications due to use of potent antiplatelets and anticoagulants therefore radial access should be preferred if the operators are experienced and familiar with the technique. Methods: Total 100 pa‡…tients were included in the study in which procedure was performed by the trans radial route. All routine laboratory investigations were performed. Support of a temporary pacemaker was kept ready. All patients were prepared according to the Cardiac Catheterization Laboratory Standards. Radial artery cannulation was performed. Results: 100 patients were included in the study selected for radial route. Mean age of the patients who underwent primary CAI was 59±8.4. The most affected artery in the as shown angiography was Left anterior descending (58%) followed by Right coronary artery (41%). Least affected artery was left main (6%) and Ramus intermedius (6%). Mean of diseased vessels was 1.34 ± 1.25. Crossover from radial to femoral route was done on 5 patients of which 2 patients were having radial artery anomaly and in 3 patients arterial puncture was not successful. Mean hospital stay of the patients after procedure was 6.8 ± 2.1. Conclusion: transradial approach for coronary procedures is a safe technique and gives similar clinical results to transfemoral access. Complications at the radial access site are negligible. Length of hospital stay, time to mobilisation and cost all are reduced in the transfemoral approach.

Download Full-text

Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014994 ◽

2019 ◽

Vol 12 (1) ◽

pp. 87-93 ◽

Cited By ~ 7

Author(s):

Tanaporn Jaroenngarmsamer ◽

Kartik Dev Bhatia ◽

Hans Kortman ◽

Emanuele Orru ◽

Timo Krings

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Radial Artery ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Minor Stroke ◽

Access Site ◽

Femoral Access ◽

Radial Access ◽

Procedural Success

BackgroundFemoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.MethodsThree online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999–2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.ResultsSeven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.ConclusionRadial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.

Download Full-text

Coronary Angiogram using Distal Radial Access: A Retrospective Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47895.14576 ◽

2021 ◽

Author(s):

S Lalitha ◽

Vijay Sai ◽

. Siddarth

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Age Distribution ◽

Ulnar Artery ◽

Safe Alternative ◽

Exact Test ◽

Dose Area Product ◽

Radial Access ◽

Area Product ◽

Randomised Controlled

Introduction: Transradial access has become gold standard for percutaneous coronary catheterisation procedures. As the learning curve overcomes, safe alternative access sites such as Distal Radial Artery (DRA), ulnar artery have been tried. Aim: The aim of this study was to generate best evidence for using right DRA for coronary angiography. Materials and Methods: In this retrospective study, a novel route in addition to radial artery was studied. A total of 150 cases who underwent the angiogram by the DRA technique were included in the study, preserving the radial artery for various procedures. DRA was punctured in anatomical snuffbox by standard techniques and coronary angiography was performed. The evaluated parameters included the characteristics of patients (gender and age distribution), blood pressure (systolic and diastolic), mean arterial pressure, flouro time, puncture time, Dose Area Product (DAP) and cumulative air kerma. Fisher’s-exact test was used to find out the association between the gender, hypertension, diabetes and the success of puncture. Results: There was 93.4% successful puncture rate for distal radial access. There was no influence of age on the success of puncture. The association of success of puncture with gender, hypertension and diabetes was not statistically significant. Conclusion: This study presents that the distal radial approach is feasible and relatively safe. Further randomised controlled trials may be required to establish this relatively new approach as the standard care.

Download Full-text