Abstract 366: Procedure Change To Reduce Radial Artery Compression Device Bleeding Following Radial-approach Angiography: A Single Centre’s Preliminary Results.

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Vanessa Lee ◽  
Toni Davey ◽  
Ellen Kenny ◽  
Kath Cowie ◽  
Nicholas Cox
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Compression Device ◽  
Radial Access ◽  
Initial Volume ◽  
Post Procedure ◽  
Retrospective Audit ◽  
Percutaneous Coronary ◽  
Prolonged Recovery

Background: Radial access is an increasingly common approach to coronary angiography whereby a radial artery compression device (RACD) is applied to achieve haemostasis following sheath removal. Current procedure recommends the removal of 5mL of air at 5-minutely intervals from the RACD; 45 minutes post angiogram sheath removal and 2 hours post PCI (Percutaneous Coronary Intervention) sheath removal. Haemostasis failure at the puncture site however was frequently reported and required re-insertion of air. Patients reported increased discomfort and, in 44% of elective cases, post-procedure stay was increased and discharge delayed by 30-180 minutes as a result of prolonged recovery time. Methods: Hospital procedure was revised to remove 3mL volume (air) at 5-minutely intervals from the RACD instead of 5mL. The RACD was also to remain untouched for 60 minutes post angiogram sheath removal and remained at 2 hours untouched post PCI sheath removal. A retrospective audit was conducted pre- and post-procedure change and included patients undergoing radial-access angiogram or PCI Results: A total of 258 cases were reviewed; 158 angiogram and 100 PCI. Initial volume of air used to achieve haemostasis was 10-18mLs and heparin dose administered was 2000-10,000units. Prior to procedure change, 5mL (air) was removed from the RACD and subsequently haemostasis failure occurred in 43.8% (35) of angiogram patients and 55.1% (27) of PCI patients. Following implementation of the 3mL procedure, haemostasis failure was reported in 12.8% (10) of angiogram patients and 19.6% (10) of PCI patients. Conclusion: Whilst total time taken to remove the RACD marginally increased, decreasing the volume of air removed from 5mL to 3mL significantly reduced the incidence of haemostasis failure. This effect was achieved without adjustment of anticoagulation dose or initial volume of air inserted into the RACD.

Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Lianna Xie ◽  
Xianjing Wei ◽  
Zezhou Xie ◽  
Shengying Jia ◽  
Siwei Xu ◽  
...  
Keyword(s):  
Radial Artery ◽  
Interventional Procedure ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Artery Cannulation ◽  
St Segment Elevation ◽  
Radial Access ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

<b><i>Objective:</i></b> Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI). <b><i>Methods:</i></b> We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed. <b><i>Results:</i></b> Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26–94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (&#x3c;2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%). <b><i>Conclusion:</i></b> dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.

Abstract 13877: Comparison of Incidence of Radial Artery Occlusion in Patients Undergoing Trans-radial Intervention With or Without a Sheath: A Prospective Cohort Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ghanshyam Palamaner Subash Shantha ◽  
Samir B Pancholy
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Study Cohort ◽  
Diabetes Diagnosis ◽  
Introducer Sheath ◽  
Effect Modifier ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Introduction: Sheathless transradial access, by decreasing the profile of hardware, is expected to lower the incidence of radial artery occlusion (RAO). Hypothesis: We sought to compare the risk of RAO in patients undergoing coronary intervention with introducer sheath (SG) or without introducer sheath (SLG). Methods: 1251 consecutive patients undergoing 6 French percutaneous coronary intervention (PCI) between January 1, 2009 and December 31, 2013 in Scranton, PA, formed the study cohort. Radial artery patency was assessed using reverse Barbeau’s test and RAO was confirmed by ultrasonography. Unadjusted, adjusted and propensity matched association between type of radial access (SG vs SLG) and RAO were assessed using logistic regression analysis. Results: Mean age was 65 years, 63% were men 37% were diabetics. 78% attained patent hemostasis (PH). Patients in SG had lower pre-discharge RAO [unadjusted (OR: 0.31, 95% CI: 0.21 - 0.46, P < 0.001), adjusted (OR: 0.10, 95% CI: 0.05 - 0.20, P < 0.001) and propensity matched (OR: 0.20, 95% CI: 0.13 - 0.32, P < 0.001)], 24 hours RAO [unadjusted (OR: 0.20, 95% CI: 0.12 - 0.34, P < 0.001), adjusted (OR: 0.12, 95% CI: 0.06 - 0.24, P < 0.001) and propensity matched (OR: 0.13, 95% CI: 0.07 - 0.25, P < 0.001)] and 30 day RAO [unadjusted (OR: 0.28, 95% CI: 0.14 - 0.54, P < 0.001), adjusted (OR: 0.22, 95% CI: 0.10 - 0.50, P < 0.001) and propensity matched (OR: 0.18, 95% CI: 0.10 - 0.40, P < 0.001)], compared to those in SLG. Spontaneous recanalization rates were significantly higher in SG compared to SLG at 24 hours (62% Vs 38%, P = 0.007) but similar at 30 days (38% Vs 50%, P = 0.338) post PCI. Diabetes diagnosis was an effect modifier for RAO at pre-discharge, 24 hours and 30 days post PCI. Conclusions: Sheath use during radial access for PCI, despite diametrically increasing hardware profile, is associated with less RAO, likely by reducing friction induced intimal trauma. Diabetes is an effect modifier in this association.

Safety and efficacy of different arterial pressure bandages following percutaneous coronary interventions from radial access: preliminary data of the RAD-PRESS trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Nemeth ◽  
F Nowotta ◽  
Z Ruzsa ◽  
T Szuk ◽  
D Becker ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cost Effective ◽  
Artery Occlusion ◽  
Percutaneous Coronary Interventions ◽  
Puncture Site ◽  
Hematoma Formation ◽  
Radial Access ◽  
Compression Time ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Abstract Background The overwhelming majority of diagnostic coronary angiographies and percutaneous coronary interventions (PCIs) are performed via radial access as recommended by the current European revascularization guidelines. Using dedicated pressure bandages for the radial access site in high-volume centres can be a significant part of the budget of catheterization laboratories, therefore we developed a cost-effective pressure bandage utilizing wrapped empty glass vials of intravenous medications. Furthermore, compression time of the radial puncture site following PCI is a predictor of radial artery occlusion, therefore shortening the period of compression to as short as possible is feasible. Purpose Our aim was to validate efficacy and safety of our cost-effective pressure bandage by comparing it to two dedicated devices, as well as reducing length of compression to as short as possible. Methods We designed the RAD-PRESS trial, major inclusion criteria of which were first puncture of a radial artery with a diameter greater than 1.8mm, PCI performed as per guidelines utilizing a 6 French guiding catheter and age below 80 years. Patients were then randomized to receive one of three pressure bandages: the glass vial, Seal-One or the gold standard TR-band. Release of pressure was performed as fast as possible in 10-minute steps, and guided by pulse oximetry. Hematoma formation was thoroughly checked for all patients and categorized using the Easy scale. Radial artery patency was investigated by ultrasound 24 hours after final removal of the bandage. The data of 40 patients of every group was analysed. Results Population characteristics were similar among the groups. Length of compression time (126±10, 142±11 and 144±11 mins for Vial, Seal-One and TR-band, respectively, p&gt;0.05), hematoma formation (Easy Grade 1 in 17.5%, 15.0% and 10.0%, Easy Grade 2 in 5.0%, 7.5% and 7.5% for Vial, Seal-One and TR-band, respectively, all p&gt;0.05) were not significantly different among the groups. Radial artery occlusion occurred in only 2 patients (Vial and TR-Band groups), accounting for 1.7% of the cases. Conclusions The cost-effective wrapped vial strategy to compress the radial puncture site was comparable to both Seal-One and the gold standard TR-band regarding safety and efficacy. Furthermore, compression time could be safely shortened to approximately 2.5 hours. Funding Acknowledgement Type of funding source: None

P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tokarek ◽  
A Dziewierz ◽  
K Plens ◽  
T Rakowski ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Access Site ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary

Abstract Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09). Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

scholarly journals Distal radial access. Occlussion of the radial artery after percutaneus coronary intervention with radial access

2021 ◽  
Vol 27 (4) ◽  
pp. 80-84
Author(s):  
Darko Kitanoski ◽  
Arman Postadzhiyan ◽  
Vasil Velchev ◽  
Nikolay Stoyanov ◽  
Zhan Zimbakov ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Pain Syndrome ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Artery Pseudoaneurysm ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
European Society Of Cardiology

In 2015, The European Society of Cardiology for Acute Coronary Syndrome recommended that Class I use radial as the preferred access method for any percutaneous coronary intervention regardless of clinical presentation. However, the use of TRA is associated with some complications: radiation artery occlusion (RAO) (The reported incidence of RAO is highly variable in the range of 2-11%, radial arterial spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome. Limited data are available regarding the technique of distal radial access, complications, and potential benefits. The purpose of our study is to compare the incidence of radial artery occlusion between distal radial and conventional radial access. The study included 292 patients (who underwent percutaneous coronary intervention)in who is felt pulsations at the site of a puncture of the radial artery. Patients were followed one month after the procedure, with Doppler ultrasonography or access from the same artery. After a month, the occlusion of the radial artery occurred in 8 (5.7%) patients in conventional radial access, there was no occlusion of the radial artery in the distal radial access group. This investigation shows that distal radial access is associated with a lower incidence of occlusion of the radial artery.

Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computed tomography for chronic coronary total occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Habara ◽  
E Tsuchikane ◽  
K Shimizu ◽  
T Kawasaki
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Failure Point ◽  
Procedural Success

Abstract Objective This study was performed to evaluate the efficacy of cardiac computed tomography (CT) for antegrade dissection re-entry (ADR) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background Although PCI of CTO is a rapidly evolving field, procedure success rate remains suboptimal. Recently, ADR with Stingray device for CTO-PCI has also evolved to one of the pillar technique of the hybrid algorithm. Although the success rate of the device could be improved, it also remains not always high especially as first crossing strategy. Methods Forty eight patients with total occlusion suitable for revascularization evaluated by baseline coronary angiography and cardiac CT were enrolled in this study from April 2017 to April 2019 from 30 enrolled centers. The primary observation was procedural success. Furthermore, all puncture point with Stingray were analyzed by cardiac CT. In each point, 1) plaques on the isolated myocardial side at distal puncture site (+1 point), 2) any plaques excluded above definition at distal puncture site (+2 points), 3) calcification on both 1 and 2 at distal puncture site (+1 point) were analyzed and calculated the score (Score 0–3) (Figure 1). Results Overall procedure success rate was 95.8% (46/48) and antegrade success rate was 91.3% (42/46). Sixteen cases were succeeded with single guidewire escalation and 32 cases were attempted ADR with Stingray system. Within them, 25 cases were succeeded and 7 cases were observed puncture failure. And 3cases were succeeded with IVUS guide and 2 cases were with retrograde appTechnical success rate with stingray was 78.1% (25/32). Cardiac CT was analyzed 60 puncture sites in 32 cases which were attempted ADR with stingray system (1.88 sites/case). CT score at ADR success point was significantly smaller compare to that at ADR failure point (0.68±1.09 vs 1.77±1.09, p&lt;0.0001). Conclusions Pre procedure Cardiac CT and CT score might be useful for ADR technique in CTO PCI not only for case selection but also for puncture site selection. Figure 1 Funding Acknowledgement Type of funding source: None

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