P5611Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Ruzsa ◽  
S Nardai ◽  
B Nemes ◽  
V Orias ◽  
E Vegh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ultrasound Guidance ◽  
Vascular Complications ◽  
Patient Comfort ◽  
X Ray ◽  
Radial Access ◽  
Procedural Success ◽  
Sheathless Guiding Catheter ◽  
Major Adverse Events ◽  
Guiding Catheter

Abstract Aims The aim of our study was to demonstrate the feasibility and safety of the distal transradial approach (DTRA) for carotid artery stenting (CAS). Methods and results We included 209 consecutive patients (151 Trans-Radial Access (TRA) and 58 DTRA) treated in a single center by CAS with cerebral protection between 2016 and 2018. DTRA punctures were performed by ultrasound guidance, and the carotid artery cannulations were done using a 6.5 F coronary sheathless guiding catheter. The groups showed similar demographic profile regarding age, gender and comorbidities, however the proportion of symptomatic patients was significantly higher in the DTRA cohort (DTRA: 75,86% vs. TRA: 46.36% p<0.001). Procedural success rate was similarly high in both groups, while the overall complication rate was very low, with no major adverse events and only a few vascular complications. The cannulation times were similar, while the overall procedure length was slightly higher in the DTRA group. The cumulative X-ray dose was similarly low regardless the access used. Conclusion DTRA is a safe and effective alternative of conventional trans-radial approach for CAS, with a potential to further improve the patient comfort.

scholarly journals Sheathless Guiding Catheter from a Femoral Approach for Complex PCI- an Unusual Solution for an Often-Encountered Problem

2020 ◽  
Vol 2 (1) ◽  
pp. 01-02
Author(s):  
Zeev Israeli
Keyword(s):  
Radial Access ◽  
Femoral Approach ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Sheathless guiding catheters are a valuable tool in the catheterization labor and may assist the operator when dealing with heavily calcifies and tortuous vessels. Nevertheless, when hostile anatomy prevents successful PCI from the radial access, transfemoral use of sheathless guide can assist in overcoming these challenges in a safe manner.

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

2019 ◽  
Vol 12 (1) ◽  
pp. 87-93 ◽  
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.

Description of Technique and Short-Term Outcomes of Radial Artery Access for Vascular Disease

2020 ◽  
Vol 54 (4) ◽  
pp. 319-324
Author(s):  
Ali Khalifeh ◽  
Besher Tolaymat ◽  
Joseph Noggle ◽  
Richa Kalsi ◽  
Christine Owen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Endovascular Procedures ◽  
Perioperative Complications ◽  
Vascular Complications ◽  
Retrospective Chart Review ◽  
Patient Comfort ◽  
Complication Rates ◽  
Arterial Access ◽  
Radial Access ◽  
Manual Pressure

Objectives: Radial artery access is widely utilized in coronary angiography with reported lower rates of vascular complications and better patient comfort. There is limited data in the literature regarding radial access in peripheral endovascular procedures. We hypothesize that radial access is safe and feasible for peripheral endovascular procedures. Methods: A retrospective chart review was performed for all patients who underwent angiography using radial artery access between August 2013 and December 2017. Patient demographics and perioperative data were recorded and analyzed. Patient Selection: The operating surgeon screened patients presenting for elective angiography for possible radial artery access. Ultrasound guidance was used in all cases. Upon cannulation, the sheath was infused with an antispasmodic cocktail, and the patients were systemically anticoagulated. Results: Forty-seven out of 52 patients successfully completed their procedure (90% success rate). The patients were mostly female (60%), elderly (mean age of 71 years), and had several comorbidities. Preoperative diagnoses were variable. Procedures were both diagnostic (58%) and interventional (42%) with maximum sheath size used being 7F and median fluoroscopy time of 7.5 minutes. Only 2 patients experienced perioperative complications, and both of these were minor hematomas that resolved with manual pressure. Conclusions: Transradial arterial access for peripheral vascular angiography and interventions is safe and feasible. With low complication rates and increased patient comfort, transradial access serves as an excellent alternative to transfemoral access for a variety of endovascular procedures.

scholarly journals Procedural Success With Radial Access for Carotid Artery Stenting: Systematic Review and Meta-analysis

2019 ◽  
Vol 70 (4) ◽  
pp. 1378 ◽  
Author(s):  
T. Jaroenngarmsamer ◽  
K.D. Ghatia ◽  
H. Kortman ◽  
E. Orru ◽  
T. Krings
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Radial Access ◽  
Procedural Success

Rotational Atherectomy Through Radial Access With a 7.5 Fr Sheathless Guiding Catheter

2011 ◽  
Vol 64 (3) ◽  
pp. 247-248
Author(s):  
Iñigo Lozano ◽  
Juan Rondan ◽  
Pablo Avanzas ◽  
Concepción Suárez
Keyword(s):  
Rotational Atherectomy ◽  
Radial Access ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

scholarly journals Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting

2018 ◽  
Vol 47 (2) ◽  
pp. 682-688 ◽  
Author(s):  
Songhe Shen ◽  
Xiongjing Jiang ◽  
Hui Dong ◽  
Meng Peng ◽  
Zhixue Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contrast Agent ◽  
Aortic Arch ◽  
Carotid Artery Stenting ◽  
Influential Factor ◽  
Fluoroscopy Time ◽  
Type I ◽  
Technical Indicators ◽  
Type Iii ◽  
Guiding Catheter

Objective This study was performed to explore the effect of the aortic arch type on technical indicators in patients undergoing carotid artery stenting (CAS). Methods The data of 224 consecutive patients who underwent unilateral CAS from January 2011 to December 2012 were retrospectively analyzed. The requirement for placement of the guiding catheter into the common carotid artery with assistance of an angiographic catheter, fluoroscopy time, contrast agent dose, and adverse events were recorded. Results The fluoroscopy time was significantly longer and the contrast agent dose was significantly higher in patients with Type III than Type I and II arches. Significantly more patients with Type III than Type I and II arches required placement of the guiding catheter with assistance of an angiographic catheter (46.2% vs. 15.0%, respectively). The procedural success rate was significantly lower in patients with Type III than Type I and II arches (96.2% vs. 100.0%, respectively). The incidence of death, myocardial infarction, and all types of stroke was significantly higher in patients with Type III than Type I and II arches (7.7% vs. 1.7%, respectively). Conclusions The aortic arch type is an important influential factor in CAS. Type III arches are associated with more difficulties and complications.

scholarly journals Internal carotid artery dissection in a patient with Ehlers-Danlos syndrome type IV: diagnosis and management

2013 ◽  
Vol 12 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Michel Nasser ◽  
Murilo Bucci Vega ◽  
Luca Giovani Antonio Pivetta ◽  
Ana Izabel Nasser ◽  
Debora Gusmao Melo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Vascular Complications ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Ehlers Danlos Syndrome ◽  
Type Iv ◽  
Danlos Syndrome

Ehlers-Danlos syndrome (EDS) type IV, also known as vascular EDS, is an inherited connective tissue disorder with an estimated prevalence of 1/100,000 to 1/250,000. In EDS type IV, vascular complications may affect all anatomical areas, with a preference for large- and medium-sized arteries. Dissections of the vertebral and carotid arteries in their extra- and intra-cranial segments are typical. The authors report the case of a patient with EDS type IV for whom the diagnosis was established based on clinical signs and who developed internal carotid artery dissection at the age of 44 years. In the absence of a specific treatment for EDS type IV, medical interventions should focus on symptomatic relief, prophylactic measures, and genetic counseling. Invasive imaging techniques are contraindicated, and a conservative approach to vascular complications is usually recommended.

scholarly journals Performance Analysis of a Novel Hydrophilic-Coated Transradial Guiding Catheter

2021 ◽  
Vol 4 (4) ◽  
pp. 01-06
Author(s):  
A.J.J. IJsselmuiden
Keyword(s):  
Coronary Intervention ◽  
Complication Rates ◽  
Stent Deployment ◽  
Coronary Syndrome ◽  
Timi Grade ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
Grade 3 ◽  
Guiding Catheter

Aim: The transradial approach (TRA) has taken an upswing, however access-site complications still exist. The choice of potentially less traumatic materials may minimize these complications. This article describes the use of a hydrophilic-coated 6F guiding catheter for diagnostic and interventional procedures and upper extremity dysfunction following these procedures. Materials and Methods: This prospective observational study enrolled 217 patients who underwent elective transradial percutaneous coronary intervention (TR-PCI) for stable and unstable angina, or acute coronary syndrome between May 2014 and November 2016. All patients were treated using a 6F hydrophilic-coated guiding catheter (PRIMUM, PendraCare, Wellinq, the Netherlands). Catheter performance was assessed on a five-point scale ranging from very bad to very good. Procedure safety was assessed using the Major cardiac and cerebrovascular events (MACCE) criteria. Results: The average number of guiding catheters used was 1.2 per patient. Overall performance of the catheters was rated Average/Good. Procedural success, defined as TIMI grade 3 flow and successful stent deployment, with a residual diameter stenosis of <25%, was 97.7%. MACCE occurred in 1.5% during the 6-months of follow-up. Conclusion: These data indicate that the use of a hydrophilic-coated guiding catheter to perform percutaneous coronary interventions is safe and effective, with high procedural success and low complication rates. In addition, the short and long-term MACCE outcomes of the PCI were favorable.

scholarly journals Comparison of Distal Transradial in the Anatomical Snuffbox versus Conventional Transradial Access for Coronary Angiography and Intervention-An Experience in 100 cases

2018 ◽  
Vol 13 (2) ◽  
pp. 40-45 ◽  
Author(s):  
Md Rasul Amin ◽  
Chayan Kumar Singha ◽  
Sajal Krisna Banerjee ◽  
Harisul Hoque ◽  
SM Ear E Mahabub ◽  
...  
Keyword(s):  
Radial Artery ◽  
Coronary Bypass ◽  
Coronary Angiogram ◽  
Cross Sectional ◽  
Radial Access ◽  
Transradial Access ◽  
Feasible Option ◽  
Procedural Success ◽  
Venous Fistula ◽  
Distal Radial Artery

Background: Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve.Objectives:This study sought to compare the feasibility, safety and complications of coronary angiogram and intervention betweenthe distal transradial in the anatomical snuffbox and conventional transradial access.Methods: In this cross sectional studya total of 100 patients were assigned to perform coronary angiogram or intervention through conventional transradial accessand distal transradial in the anatomical snuffboxfrom November 2017 to April 2018 in theDepartment of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU). We divided the total patient in two groups, with 50 patientsin each group. All of them had normal pulse in theirradial and dorsal radial artery.One group was subjected toconventional right transradial accessand another to rightdistal transradial in the anatomical snuffbox.Demographic features &complications were recorded.Results: The overall procedural success was 98% which was greater than expected in our early clinical experience for distal transradial access with 48 successful accesses out of 50 patients and for conventional radial approach it was also 98%.There was failure to access of distal radial artery in two casesthat may be due to hypoplastic/vasospastic distal radial artery and for conventional radial artery radial artery spasm was the cause. Patients of conventional radial access had more spasm, hematoma, numbness and hospital stay (p< 0.001) than distal radial access. Considering all, it may be said thatdistal transradialaccess was very much effective and safe as there was less spasm, more comfortable to the patient, no hand ischemia, hematoma, numbness, and early hospital discharge.Conclusion: Distal transradial access in the anatomical snuffbox for coronary angiogram and intervention is abetter alternative, safe and feasible option to conventional transradial access for both patients and operators.University Heart Journal Vol. 13, No. 2, July 2017; 40-45

Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Ultrasound Guidance ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

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