Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review

2022 ◽  
pp. 152660282110677
Author(s):  
Ganwei Shi ◽  
Feng Li ◽  
Liuyan Zhang ◽  
Chun Gong ◽  
Sheliang Xue ◽  
...  
Keyword(s):  
Literature Review ◽  
Success Rate ◽  
Radial Artery ◽  
Cardiac Catheterization ◽  
Case Series ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Total Occlusion ◽  
Single Centre Experience ◽  
The Common

Purpose: Radial artery occlusion (RAO) is one of the common complications after coronary intervention via the conventional radial artery approach. The purpose of the study was to explore the safety and feasibility of retrograde recanalization of the occluded radial artery via a distal radial artery (DRA) approach. Methods: Combined with the practice of our centre and a literature review, we summarized the procedure of retrograde recanalization of RAO, success rate, and complications. Results: A total of 14 of 15 patients with 15 pieces of occluded radial arteries were successfully recanalized via the DRA in our centre. In the 15 occluded vessels, 11 vessels (73.3%) had total occlusion and 4 vessels (26.7%) had functional occlusion. Four of 15 occluded vessels were acute occlusions. Two acute RAOs were only treated with aspiration via sheath, 11 RAOs with balloon angioplasty, and 2 RAOs with both, respectively. In 6 patients, cardiac catheterization was carried out via the DRA after recanalizing the RAO. A total of 10 studies reporting the results of recanalization of RAO via the DRA were systematically retrieved in the present study. In 3 case series, the number of cases was more than 5, and the success rate of recanalization was more than 85.7%. Two studies reported complications, including dissection in one case, hematoma in 2 cases, and pain in the forearm during angioplasty. Conclusions: Recanalization of the occluded radial artery via the DRA was safe and effective. When repeat cardiac catheterization was required, recanalization of the RAO and subsequent coronary angiography or intervention through the ipsilateral radial artery approach was feasible.

scholarly journals Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Wei-Chieh Lee ◽  
Chieh-Ho Lee ◽  
Wen-Jung Chung ◽  
Shu-Kai Hsueh ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Procedural Success

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

scholarly journals Same-day dual radial artery puncture examination in patients requiring percutaneous coronary intervention and the incidence of radial artery occlusion

2018 ◽  
Vol 12 (3) ◽  
pp. 77-84 ◽  
Author(s):  
Daniel Brancheau ◽  
Sachin Kumar Amruthlal Jain ◽  
Patrick B. Alexander
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Duplex Ultrasound ◽  
Coronary Intervention ◽  
The United States ◽  
Artery Occlusion ◽  
Total Occlusion ◽  
Ultrasound Evaluation ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Background: We sought to investigate the rate of radial artery occlusion (RAO) after same-day dual radial artery puncture. The trans-radial arterial approach (TRA) for diagnostic and interventional procedures has risen significantly in the United States. Although becoming more commonly performed, TRA is not without risk, and a potential complication is RAO. The rate of RAO after same-day dual artery puncture is unknown. Methods: A retrospective analysis of 27 patients who underwent same-day dual radial artery puncture for percutaneous coronary intervention (PCI) at our institution (Providence Heart Institute in Southfield, MI, USA) from November 2011 to December 2013 were included after initially presenting for cardiac catheterization at a non-PCI-capable facility. The study patients were asked to follow up for evaluation of the radial artery, including obtaining a duplex ultrasound evaluation. Results: The mean age of the patients was 65 years old with 66% of the patients being male. Of the 27 study participants, there were no symptoms reported that were related to RAO. Overall, one (3.7%) patient had an absent radial pulse. The modified Allen’s test was normal in all of the patients with a mean return of palmar flush time of 4 seconds. Duplex ultrasound revealed subtotal RAO in four (14.8%) patients and no patients experienced total occlusion following the intervention. Conclusion: Dual radial artery puncture appears to be a well-tolerated and viable strategy in patients that are transferred to a PCI-capable hospital for coronary interventions.

scholarly journals Radial Artery Patency after Trans-radial Cardiac Catheterization in a Bangladeshi Population

2015 ◽  
Vol 10 (2) ◽  
pp. 66-72
Author(s):  
Mashhud Zia Chowdhury ◽  
CM Shaheen Kabir ◽  
Sahela Nasrin ◽  
Hemanta I Gomes ◽  
Md Enamul Hakim ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cardiac Catheterization ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Diastolic Velocity ◽  
Study Population ◽  
Bangladeshi Population

Background: Transradial cardiac catheterization (TCC) is now preferred method over trans-femoral approach globally including Bangladesh. But the incidence of radial artery occlusion (RAO) after TCC is not infrequent and it ranges from 1-18% in different studies. The aim of our study was to see the incidence of RAO after TCC in a population coming for coronary angiogram and/or coronary intervention and also to evaluate the factors responsible for RAO. Methods: The observational prospective study was performed in all consecutive patients coming for TCC. Pre and three month post-procedural modified Allen’s test, reverse Barbeau test & Duplex ultrasonography for radial artery diameter (RAD), peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were measured. Results: 69 patients underwent TCC. Mean age was 54 years, 67% were male, 80% hypertensive, 65% diabetic. Follow-up at third month showed one total RAO (1.45%) and mean RAD of the remaining patients was significantly reduced from 2.2+0.03 mm to 2.1+0.03 mm (p=0.001) but none had any symptom or sign of ischemic hand. PSV, EDV & RI were not significantly altered. Reduction of RAD (to <2.0 mm) were significantly higher in female (p=0.032), but no association was found in presence of diabetes or its duration, hypertension, dyslipidaemia, smoking, peripheral vascular disease. The size & number of catheters used or duration of vascular access sheath kept in the artery did not affect the reduction of RAD.Conclusion: The mean RAD of the study was smaller than other study population, but incidence of RAO is very low. RAD was significantly reduced after procedure without any clinical evidence of ischemia or alteration of flow velocity. Female sex was the only factor found to be associated with reduction of RAD in this study.University Heart Journal Vol. 10, No. 2, July 2014; 66-72

scholarly journals Intimal sarcoma arising from the common iliac artery presenting with artery occlusion : a case report and literature review

2019 ◽  
Vol 66 (1.2) ◽  
pp. 205-208 ◽  
Author(s):  
Masashi Kano ◽  
Toshihiko Nishisho ◽  
Ryo Miyagi ◽  
Fumio Chikugo ◽  
Eiji Kudo ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Iliac Artery ◽  
Common Iliac Artery ◽  
Artery Occlusion ◽  
Intimal Sarcoma ◽  
The Common

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

Low-molecular-weight-heparin in radial artery occlusion treatment: the LOW-RAO randomized study

2021 ◽  
Author(s):  
Matthaios Didagelos ◽  
Areti Pagiantza ◽  
Thomas Zegkos ◽  
Christos Papanastasiou ◽  
Konstantina Zarra ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Radial Artery ◽  
Low Molecular Weight Heparin ◽  
Controlled Trial ◽  
Randomized Study ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Low Molecular Weight ◽  
Open Label ◽  
Radial Artery Occlusion

Radial artery occlusion (RAO) is the commonest complication of transradial catheterization. There is no evidence-based therapy, in the frame of a randomized control study, for the treatment of RAO. The purpose of the LOW-RAO study is to question the hypothesis if low-molecular-weight heparin is effective in the treatment of RAO after transradial coronary catheterization (both angiography and percutaneous coronary intervention). It is a prospective, open label, randomized controlled trial that will randomize 60 patients with RAO, irrespective of symptoms, into two groups, one receiving anticoagulation with low-molecular-weight heparin and the other receiving no treatment. The primary end point is improvement in radial artery patency rate at 4 weeks after the procedure. Trial registration number: NCT04196309 (ClinicalTrials.gov)

scholarly journals The retrograde technique for recanalization of chronically occluded coronary arteries: Case series report

2020 ◽  
pp. 124-124
Author(s):  
Stefan Juricic ◽  
Milorad Tesic ◽  
Milan Dobric ◽  
Srdjan Aleksandric ◽  
Zlatko Mehmedbegovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Case Series ◽  
Interventional Cardiology ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Special Technique ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Increased Risk

Background. Chronic total occlusion (CTO) of coronary artery still represents one of the most challenging lesion subset in field of interventional cardiology. Considering the complexity and increased risk posed by the retrograde approach, it is most often performed after a failed antegrade approach. Methods. We present a series of cases dedicated to the retrograde approach as a special technique for the treatment of chronic total coronary artery occlusion. All cases have some special characteristics that are today part of a dedicated portfolio in every cath lab. Results. In our series of cases all of three percutaneous coronary interventions (PCI) with retrograde approach finished with successful recanalization of CTO with different strategy and supported with rotational atherectomy (RA) or intravascular ultrasound (IVUS). Conclusion. In cases where there is the presence of interventional collaterals, as well as when the anterograde approach is very difficult, the retrograde approach can increase the success rate of procedures. The retrograde approach requires a long learning curve as well as very skilled and experienced operators who are able to perform the procedure independently.

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

Circulation ◽  
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.

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

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.

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