P1814A novel method of transradial approach for left ventricular endomyocardial biopsy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M I N G Lan ◽  
Q I N G He
Keyword(s):  
Radial Artery ◽  
Endomyocardial Biopsy ◽  
Diagnostic Yield ◽  
Clinical Importance ◽  
Left Ventricular ◽  
Skin Dose ◽  
Complication Rates ◽  
Transradial Access ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Background Left ventricular endomyocardial biopsy (LV-EMB) may offer a superior diagnostic yield compared with right ventricular endomyocardial biopsy (RV-EMB) in conditions predominantly affecting the LV. Recently, transradial way is used for LV-EMB, and it has lower complication rates and has an advantage of immediate post-procedural ambulation compared with transfemoral technique. Previous reports of transradial LV-EMB need relatively complicated sheathless guiding catheter exchanging. Purpose We aimed at finding a novel and easier transradial method with a 6F sheath and a 6F guiding catheter. Methods and results In this manuscript, we described a method that allowed interventional cardiologists to obtain LV-EMB via transradial access with a 6F sheath and a 6F guiding catheter. This technique was successfully conducted in 25 consecutive patients at our institution. The transradial success rate was 100% (25 of 25). Mild or moderate radial artery spasm occurred in only 1 (4%) patient, but no severe radial spasm was observed. All the patients were performed coronary angiography and left ventricular angiogram according to the indication, and they were performed EMB through the same radial sheaths without sheathless guiding catheter exchanging. Heparin was administered to 100% of patients at a dose of 5000IU. Median fluoroscopy time was 13.45min. Median total skin dose was 1478mGy. Median area product was 15486 cGy·cm2. All biopsy samples were graded as excellent quality. Immediate patient mobilization could be achieved in all patients. Radial artery patency was confirmed by doppler ultrasonography 24 hours after the sheath removal. There were no major complications (pericardial tamponade, life-threatening arrhythmia, cerebrovascular accident or death). Transradial LV-EMB with a 6F sheath Conclusions The present article demonstrates a result of feasibility, safety and efficacy of a novel transradial access for LV-EMB using a 6F sheath and a 6F guiding catheter. This is of clinical importance since this new technique may overcome the currently existing methods, and may be regarded as an interventional “one stop shop” technique.

Abstract 18891: Prospective Evaluation of Diagnostic Performance and Safety of Implementing a Biventricular Approach for Endomyocardial Biopsy in Patients With Suspected Myocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philipp Lurz ◽  
Felix Foehrenbach ◽  
Christian Luecke ◽  
Daniel Urban ◽  
Enno Boudriot ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Diagnostic Performance ◽  
Diagnostic Yield ◽  
Major Complication ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Myocardial Tissue ◽  
Major Complication Rate ◽  
Antigen Presenting ◽  
Guiding Catheter

Background: Previous retrospective analyses have suggested that biventricular (BV) endomyocardial biopsy (EMB) is superior to right (RV) or left ventricular (LV) EMB only in diagnosing patients with suspected myocarditis. Aim: To prospectively assess the feasibility, safety and diagnostic yield of BV EMB in consecutive patients with suspected myocarditis. Methods: Five to six EMBs were taken from the RV and LV under fluoroscopic guidance. Biopsies were analyzed in a core lab by highly experienced investigators (KK, RK) Myocarditis/myocardial in[[Unable to Display Character: fl]]ammation was de[[Unable to Display Character: fi]]ned as the detection of ≥14 infiltrating leukocytes/mm2 (CD3 T-lymphocytes and/or CD68 macrophages) in addition to enhanced HLA class II expression in professional antigen-presenting immune cells. Results: 100 consecutive patients (mean age 44 ± 15 years) with clinically suspected myocarditis were included. RV EMB was attempted in 100 patients, in 3 the procedure was abandoned due to unsatisfying positioning on the guiding catheter, in 1/97 RV EMBs were inadequate with no myocardial tissue obtained. LV EMB was attempted in 97 patients, in 3, LV EMB was not performed due to presence of LV thrombi, in 1/97 patient LV EMBs were inadequate with no myocardial tissue obtained. Major complication rate for LV EMB was 0% and for RV EMB, 1% (pericardial tamponade requiring surgical revision). Results of adequate BV EMBs were analyzed in 92 patients. On BV EMB, myocarditis was diagnosed in 61/92 patients. When considering LV EMB only, the diagnosis would have been missed in 3/61, when considering RV EMB only in 7/61 patients. Conclusion: BV EMB is feasible and safe in the majority of patients with suspected myocarditis and yields in a superior diagnostic performance as compared to a single ventricle EMBs.

scholarly journals Feasibility of Transradial Coronary Intervention Using a Sheathless Guiding Catheter in Patients With Small Radial Artery

2011 ◽  
Vol 41 (3) ◽  
pp. 143 ◽  
Author(s):  
Young Jin Youn ◽  
Junghan Yoon ◽  
Sang Woo Han ◽  
Jun-Won Lee ◽  
Joong Kyung Sung ◽  
...  
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

scholarly journals Is This the Prime Time for Transradial Access Left Ventricular Endomyocardial Biopsy?

2021 ◽  
Vol 16 ◽  
Author(s):  
Zaccharie Tyler ◽  
Oliver P Guttmann ◽  
Konstantinos Savvatis ◽  
Daniel Jones ◽  
Constantinos O’Mahony
Keyword(s):  
Pericardial Effusion ◽  
Endomyocardial Biopsy ◽  
Observational Studies ◽  
Left Ventricular ◽  
Prime Time ◽  
Common Complication ◽  
Transradial Access ◽  
Guide Catheter ◽  
Feasible Alternative ◽  
The Right

Left ventricular endomyocardial biopsy (EMB) is an essential tool in the management of myocarditis and is conventionally performed via transfemoral access (TFA). Transradial access EMB (TRA-EMB) is a novel alternative and the authors sought to determine its safety and feasibility by conducting a systematic review of the literature. Medline was searched in 2020, and cohort demographics, procedural details and complications were extracted from selected studies. Four observational studies with a combined total of 496 procedures were included. TRA-EMB was most frequently performed with a sheathless MP1 guide catheter via the right radial artery. The most common complication was pericardial effusion (up to 11% in one study), but pericardial drainage for tamponade was rare (one reported case). Death and mitral valve damage have not been reported. TRA-EMB was successful in obtaining samples in 99% of reported procedures. The authors concluded that TRA-EMB is a safe and feasible alternative to TFA-EMB and the most common complication is uncomplicated pericardial effusion.

Feasibility and safety of left ventricular endomyocardial biopsy via transradial access: Technique and initial experience

2015 ◽  
Vol 86 (4) ◽  
pp. 761-765 ◽  
Author(s):  
Eberhard Schulz ◽  
Alexander Jabs ◽  
Tommaso Gori ◽  
Ulrich Hink ◽  
Efthymios Sotiriou ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Left Ventricular ◽  
Initial Experience ◽  
Transradial Access ◽  
Access Technique

Sheathless guiding catheter versus “slender” sheath/guiding catheter combination in acute coronary syndrome: a propensity-matched analysis of two downsized devices

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Isawa ◽  
K Horie ◽  
T Honda
Keyword(s):  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Coronary Syndrome ◽  
Radial Artery Occlusion ◽  
Transradial Pci ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Purpose We investigated the differences between a sheathless guiding catheter and a Glidesheath slender/guiding catheter combination regarding access-site complications in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods We enrolled consecutive 1108 patients undergoing transradial primary PCI for ACS at our hospital using either a 7.5-Fr sheathless guiding catheter (Sheathless group) or a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group); 1:1 propensity score matching was performed, and 718 subjects (359 in each group) were included in the propensity-matched sample. Results Compared with the Sheathless group, the Glidesheath group had significantly less frequent ultrasound-diagnosed radial artery occlusion at 30 days (Sheathless: 4.7% vs. Glidesheath: 1.4%, p=0.015). No significant differences were observed in severe radial spasm (Sheathless: 1.4% vs. Glidesheath: 2.0%, p=0.77) or access-site bleeding (Sheathless: 9.8% vs. Glidesheath: 8.6%, p=0.70). Conclusion Thus, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is clearly more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of radial artery occlusion in transradial PCI for ACS. “Sheathless” vs. “Glidesheath slender” Funding Acknowledgement Type of funding source: None

Transradial access for arteriovenous fistuloplasty in Singapore

2020 ◽  
pp. 112972982094664
Author(s):  
Chee Wui Ong ◽  
Enming Yong ◽  
Qiantai Hong ◽  
Sadhana Chandrasekar ◽  
Lawrence Han Hwee Quek ◽  
...  
Keyword(s):  
Radial Artery ◽  
University Hospital ◽  
Dialysis Access ◽  
Complication Rates ◽  
Artery Pseudoaneurysm ◽  
Transradial Approach ◽  
Technical Success Rate ◽  
Arteriovenous Fistulas ◽  
Transradial Access ◽  
Venous Stenosis

Background: Endovascular balloon angioplasty is standard therapy for dysfunctional arteriovenous fistula in end-stage renal failure patients on hemodialysis. Venous antegrade or retrograde puncture of the fistula is typically performed to gain access for fistuloplasty. Transradial approach for brachiocephalic or brachiobasilic arteriovenous fistulas offers an alternative method of access with the advantage of addressing multi-focal juxta-anastomotic and venous stenosis from the same approach. We aim to review the efficacy, outcomes and complication rates of transradial access for arteriovenous fistuloplasty among patients in Singapore. Methods: A retrospective review of 195 endovascular fistuloplasties from September 2017 to August 2019, at a tertiary university hospital Vascular Surgery unit. Results: Of 195 fistuloplasties, 43 (22%) were transradial approach (23 brachiocephalic arteriovenous fistulas, 20 brachiobasilic arteriovenous fistulas) in 33 patients (67% male and mean age = 65 years). Of these 43 procedures, 11 (26%) were performed as balloon-assisted maturation fistuloplasties while 32 (74%) were performed for mature arteriovenous fistulas with multi-focal juxta-anastomosis and venous stenosis. Technical success rate was 95% with mean procedure duration at 43.5 ± 14.6 min. Mean pre- and post-fistuloplasty dialysis access flow rates increased from 502 to 952 ml/min (p < 0.001). Post-intervention primary patency was 100%, 66% and 20% at 1, 6 and 12 months, respectively. There were four patients with non-limb-threatening radial artery thrombosis (9.3%) while there was no radial artery pseudoaneurysm or post-procedural bleeding. Conclusion: Transradial approach for arteriovenous fistuloplasty is a safe and feasible option in patients requiring balloon-assisted maturation or with multi-focal juxta-anastomotic and venous stenosis.

scholarly journals A new iteration for the single-access large-bore technique during impella supported complex and high-risk coronary intervention: a case report

2021 ◽  
Author(s):  
Marco Araco ◽  
Angelo Quagliana ◽  
Giovanni Pedrazzini ◽  
Marco Valgimigli
Keyword(s):  
High Risk ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Bleeding Complications ◽  
Single Access ◽  
Arterial Access ◽  
Coronary Syndrome ◽  
Sheathless Guiding Catheter ◽  
Access Technique ◽  
Guiding Catheter

Abstract BACKGROUND Complex and high-risk coronary intervention (CHIP-PCI) and PCI in cardiogenic shock complicating acute coronary syndrome is increasingly performed under mechanical circulatory support—so called protected PCI. Among the available options, Impella CP heart pump (ABIOMED) is percutaneously inserted over the femoral artery and typically requires a second arterial access to perform PCI, which further enhances the risk of vascular and bleeding complications. The single-access technique allows Impella CP placement and PCI performance through the same vascular access. When a 7-french system is desirable, only a long and entirely hydrophilic coated sheath has been previously used, which is not available in Europe. CASE SUMMARY A 85-year-old patient admitted with NSTE-ACS, severely reduced left ventricular function and three-vessel coronary artery disease underwent single access CHIP-PCI under Impella CP support. After a failed attempt to insert a standard 7-french long femoral sheath alongside the Impella catheter, we successfully introduced a 7.5-french sheathless guiding catheter and delivered the planned percutaneous treatment with the benefits conferred by a 7-french—rather than 6 - lumen catheter, without the need for an additional arterial access. DISCUSSION This is, to the best of our knowledge, the first case of CHIP-PCI performed under Impella support utilizing the single-access technique with a 7.5-french sheathless guiding catheter. Beyond advantages of the single-access technique in sparing time and avoiding vascular complications associated with gaining a second arterial access, the lower outer diameter of the sheathless catheter compared with standard 7-french sheaths may allow improved limb perfusion and lower chance of interference with the impella CP catheter.

P6522Overcoming anatomic challenges to transradial access in STEMI patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Campos ◽  
C Galvao Braga ◽  
J Costa ◽  
C Quina Rodrigues ◽  
C Costa Oliveira ◽  
...  
Keyword(s):  
Radial Artery ◽  
Small Diameter ◽  
Vascular Complications ◽  
New Technique ◽  
Femoral Access ◽  
Catheterization Laboratory ◽  
Left Circumflex Artery ◽  
Femoral Approach ◽  
Transradial Access ◽  
Guiding Catheter

Abstract Background Transradial access is associated with fewer access-related complications, earlier discharge and lower mortality, being the preferred route to perform coronary angiogram and interventions due to its safety and cost effectiveness in STEMI patients. However, the radial artery is smaller, more superficial and thinner than the femoral artery and a percentage of patients ranging from 14% to 27% have a radial artery that is smaller than a 6-French introducer, which sometimes makes angioplasty difficult. Purpose This study reports our initial experience with the 5F straight (STR) flush catheter, which can be used as a “child” type rapid exchange catheter inside the 6F guiding catheter, creating a distal tip transition, facilitating angioplasty in transradial coronary interventions when the radial artery is small, tortuous or as severe spasm that impedes advancement of guiding catheter after successful angiography with 5F catheter. Methods We analysed, retrospectively, 1510 STEMI patients (pts) admitted in our catheterization laboratory, from August of 2010 to October 2017. Of these patients, 95 (6.3%) pts with problems in advancing a 6F guiding catheter, were submitted to this technique and a direct crossover to a femoral approach was performed in 36 pts (2.4%). This technique consists in the use of longer 5F STR flush catheter in order to overcome the larger distal tip of the 6F guiding catheter through the radial access, employing a 5-in-6 F technique. Results In 89 of 95 patients (93.7%), this new technique was successful, with a mean reperfusion time since arrival to the catheterization laboratory of 24.5±9.9 minutes. Of the pts submitted to this technique the majority were female 51 (57.3%) and the mean age was 67±14.3 years. Angioplasties were performed in the left main (2; 2.3%), left anterior descending (36; 40.4%), left circumflex artery (8; 9.0%), right coronary artery (40; 44.9%), right posterior descending artery (1; 1.1%) and obtuse marginal branch (2; 2.3%). No complications in arterial access were seen. Throughout these years of study, the need for crossover to femoral approach has decreased with the learning of this technique. The time until reperfusion since catheterization laboratory arrival was 29.3±9.5 minutes when there was a crossover, being statistically higher than with the radial procedure with the STR technique (p<0.017). Conclusion This new technique may be a simple and useful approach to perform primary PCI through transradial access in patients with small diameter radial arteries, allowing a reduction of crossover to femoral access, which translates into a lower risk of vascular complications and shorter reperfusion time, that may influence the prognosis of STEMI patients.

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