Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

2021 ◽  
pp. 112972982110052
Author(s):  
Gianluca Rigatelli ◽  
Marco Zuin ◽  
Ramesh Daggubati ◽  
Dobrin Vassilev ◽  
Giovanni Zuliani ◽  
...  
Keyword(s):  
Radial Artery ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Case Control ◽  
Artery Occlusion ◽  
Case Control Studies ◽  
Access Site ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Background: A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. Objective: To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. Data sources: Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. Study eligibility criteria: Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. Study appraisal and synthesis methods: Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31–069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37–1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48–1.63, p = 0.001, I2 = 0%, respectively). Limitations: Only eight case-control studies met inclusion criteria Conclusion: This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

scholarly journals Recanalization of the occluded radial artery via distal transradial access in the anatomic snuffbox

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feng Li ◽  
Gan-Wei Shi ◽  
Bi-Feng Zhang ◽  
Xiao-Long Yu ◽  
Hao-Min Huang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Transradial Access ◽  
Vascular Ultrasonography ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion ◽  
The Right

Abstract Background Radial artery occlusion is a common complication after coronary angiography and percutaneous coronary intervention via the transradial access. In recent years, coronary angiography and percutaneous coronary intervention via the distal transradial access has gradually emerged, but recanalization of the occluded radial artery through the distal transradial access has rarely been reported. Case presentation A 67-year-old female with arterial hypertension and diabetes mellitus was admitted to the hospital due to chest pain for three hours. She was diagnosed with acute myocardial infarction. After admission, the patient successfully underwent emergency coronary angiography and percutaneous coronary intervention through the right transradial access. Radial artery occlusion was found after the operation, and recanalization was successfully performed through the right distal transradial access before discharge. Immediately after the operation and one month later, vascular ultrasonography showed that the antegrade flow was normal. Conclusions This report presents a case of radial artery occlusion after emergency coronary angiography and percutaneous coronary intervention in which recanalization was successfully performed through the right distal transradial access. This case demonstrates that recanalization of a radial artery occlusion via the distal transradial access is safe and feasible.

scholarly journals Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome

2020 ◽  
Vol 47 (4) ◽  
pp. 319-321
Author(s):  
Thomas J. Earl
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Raynaud Phenomenon ◽  
Hand Ischemia ◽  
Percutaneous Coronary ◽  
Esophageal Dysfunction ◽  
Radial Artery Occlusion ◽  
Digital Amputation

The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.

scholarly journals Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions

2021 ◽  
Vol 10 (10) ◽  
pp. 2204
Author(s):  
Oh-Hyun Lee ◽  
Ji Woong Roh ◽  
Eui Im ◽  
Deok-Kyu Cho ◽  
Myung Ho Jeong ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Radial Approach ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions ◽  
Radial Artery Occlusion

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.

scholarly journals Comparison of transradial coronary intervention for left main bifurcation disease using the new Braidin® slender 7 Fr sheath and a standard 6 Fr sheath

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095472
Author(s):  
Yingkai Xu ◽  
Yingkai Li ◽  
Jiancai Yu ◽  
Deguang Wang ◽  
Qi Zhao ◽  
...  
Keyword(s):  
Radial Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Occlusion Rate ◽  
Radial Artery Occlusion

Objectives To compare the effectiveness and safety of the Braidin® slender 7 Fr sheath with a standard 6 Fr sheath for treating left main bifurcation disease. Methods From January 2017 to March 2019, 277 patients with left main bifurcation disease who underwent the transradial approach for percutaneous coronary intervention were divided into the slender 7 Fr sheath group (Braidin® slender 7 Fr sheath, n = 154) and standard 6 Fr sheath group (n = 123). Pathological features, surgical effect, and complications were evaluated. Results The rate of using the classic crush technique was significantly higher in the slender 7 Fr sheath group than in the standard 6 Fr sheath group. The slender 7 Fr sheath group had a significantly shorter operation time than the standard 6 Fr sheath group. There were no significant differences in the radial artery occlusion rate after surgery and at 1 month of follow-up between the groups. Multivariate logistic regression analysis showed that 6 Fr and Braidin slender 7 Fr sheaths did not predict radial artery occlusion. Conclusion The Braidin slender 7 Fr sheath has a superior operative process and similar safety for the radial artery as that of the standard 6 Fr sheath for treating left main bifurcation disease.

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.

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