scholarly journals Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography

2020 ◽  
Vol 26 (6) ◽  
pp. 713-718
Author(s):  
Shoji Saito ◽  
Hitoshi Hasegawa ◽  
Tomoyoshi Ota ◽  
Toru Takino ◽  
Yuichi Yoshida ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Artery Occlusion ◽  
Transradial Approach ◽  
Novel Technique ◽  
Ultrasound Evaluation ◽  
The Mean ◽  
Cannulation Success Rate ◽  
Cannulation Success ◽  
Distal Radial Artery

Purpose We aimed to evaluate the safety and feasibility of the distal transradial approach (DTRA) as a novel technique for cerebral angiography based on our institutional initial experience. Methods We retrospectively analyzed our institutional database of consecutive diagnostic cerebral angiographies performed with DTRA from December 2018 to August 2019. Patient demographics and clinical and procedural data were recorded. Results In total, 51 diagnostic cerebral angiographies in 51 patients (age, 15–83 years; mean age, 59.4 years, SD 13.5; 35 (69%) females) were performed or attempted with DTRA. Ultrasound evaluation showed that the mean inner distal radial artery diameter was significantly smaller than the mean inner forearm radial artery diameter (2.19 mm vs. 2.56 mm, P < 0.001). Cannulation via the distal radial artery was successful in 47 (92%) procedures. In the four procedures that failed, operators converted to the ipsilateral transradial approach without repositioning or redraping. Selective catheterization of the intended vessel was achieved in 64 (91%) of 70 vessels. In the remaining six, operators achieved the objective of the examination with angiography injecting from proximal and conversion to another approach was not required. One patient experienced temporary numbness around the puncture site after the procedure. No radial artery occlusion was identified in the patients who underwent ultrasound evaluation. Conclusion Our results demonstrate that DTRA could become a standard approach for diagnostic cerebral angiography owing to the low complication rate and the high cannulation success rate.

Abstract 14475: Successive Distal Transradial Approach for Coronary Catheterization in the Same Arm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takeshi Yamada ◽  
Soichiro Washimi ◽  
yuki matsubara ◽  
Sho Hashimoto ◽  
Norimasa Taniguchi ◽  
...  
Keyword(s):  
Radial Artery ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Artery Occlusion ◽  
Access Site ◽  
Transradial Approach ◽  
Coronary Catheterization ◽  
Initial Procedure ◽  
Second Procedure ◽  
Distal Radial Artery

Background: The distal transradial approach (dTRA) for coronary catheterization is a newly introduced alternative to the conventional transradial approach. This study investigated how many times the same distal radial artery can be cannulated for coronary catheterization. Methods: A total of 1717 patients underwent 2406 coronary catheterization procedures between April 2018 and March 2020. The dTRA was used as the primary approach whenever feasible in this study period, and the dTRA was used for 1555 patients (90.6%) and 2129 procedures (88.5%). Patients who underwent repeated coronary catheterization after the initial procedure using dTRA were included in this study. The incidence of successive application of dTRA in the same arm and the reasons for access site conversion were investigated. Results: A total of 430 patients were included in this study; of these, in 10 patients, the distal radial artery was cannulated on both sides in the initial procedure. The patient group included 320 men (74.4%), and the mean age was 72.2 ± 10.8 years. A 4-, 5-, or 6-French sheath or sheathless system was used in the initial procedure. A maximum of four successive coronary catheterization procedures, including the initial procedure, were carried out. The second procedure involved the distal radial artery on the same side in 394 cases (89.5%), and the fourth dTRA procedure was possible in 81.7% of the cases. Access site conversion during the follow-up procedure, which was observed in 57 cases, was attributed to radial artery occlusion (17.5%), narrowing of the distal radial artery (33.4%), tortuous route of the right upper limb approach (15.8%), and strategic reasons, such as aortography or coronary bypass graft angiography (15.8%). Conclusions: The dTRA was successfully applied in the same arm in 89.5% of the cases in the second procedure and 81.7% in the fourth coronary catheterization procedure.

Abstract 14147: Vascular Complication of Distal Transradial Approach in Patients With Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takeshi Yamada ◽  
Yuki Matsubara ◽  
Soichiro Washimi ◽  
Sho Hashimoto ◽  
Norimasa Taniguchi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Radial Artery ◽  
Bleeding Complication ◽  
Artery Occlusion ◽  
Vascular Complication ◽  
Primary Pci ◽  
Transradial Approach ◽  
The Mean ◽  
Radial Artery Occlusion

Background: The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This study investigated the incidence of vascular complication of the dTRA in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods: Consecutive 131 patients with AMI who underwent primary PCI between April 2018 and October 2019 were investigated. The dTRA was used as the primary approach whenever feasible in this study period. The bleeding complication after dTRA and the patency of the radial artery were investigated. The patency of the radial artery was examined using Doppler ultrasound in follow-up period. Results: Among the 131 AMI patients, 116 patients (88.5%) underwent successful primary PCI using the dTRA. The patients included 83 men (71.6%), and the mean age was 70.4 ± 12.9 years. A 5- or 6-French sheath (conventional or slender) was used in the primary procedure. The average time to achieving hemostasis was 5.0 ± 4.1 hours; TIMI minor bleeding was observed in 2 patients (1.5%) and there were no TIMI major bleeding. Color Doppler sonography of the radial artery was performed in 94 patients with the mean follow-up period of 273 ± 183 days, and the incidence of radial artery occlusion (RAO) was 1.1% (n=1). Conclusions: The application of dTRA is considered to have low incidences of bleeding complication and radial artery occlusion in the patients with AMI.

P1761Distal transradial approach for primary percutaneous coronary intervention for patients with acute myocardial infarction: a multicentre study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Izumikawa ◽  
S Takeshita ◽  
T Yamada ◽  
Y Mizuguchi ◽  
N Taniguchi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Transradial Approach ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Distal Radial Artery

Abstract Background The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This technique is expected to decrease the incidence of haemorrhagic complications and improve patient comfort. However, limited data are available regarding the application of this technique in patients with acute myocardial infarction (AMI). This study investigated the feasibility and safety of the dTRA for primary percutaneous coronary intervention (PCI) in patients with AMI. Methods This study included patients with AMI who underwent primary PCI via the distal radial artery across 3 Japanese hospitals between January 2018 and January 2019. Patients' background, procedural characteristics, and clinical outcomes including the incidence of haemorrhagic complications were analysed. Results This study enrolled 95 consecutive patients with AMI, including 68 patients (71.6%) with ST-segment elevation myocardial infarction (STEMI), in whom distal radial artery puncture was attempted for primary PCI. The patients included 70 men (73.7%), and the mean age was 72.2±12.4 years. Among these patients, cannulation was successfully performed in 89 patients (93.7%). A 5-, 6-, or 7-French sheath (conventional or slender) was used in this study. Cannulation was performed using a forearm radial artery approach in patients in whom dTRA failed. PCI was successfully performed in all patients. The meantime to achieve haemostasis was 6.3±5.3 hours, and no major bleeding complications occurred. Based on The Early Discharge After Transradial Stenting of Coronary Arteries trial haematoma scale, grade I, II, and III subcutaneous haemorrhages were observed in 16 (16.8%), 4 (4.2%), and 1 patient (1.1%), respectively. No patient developed a haematoma > grade IV. In patients with STEMI, the mean door-to-balloon time was 39.4±31.9 min, and the mean puncture-to-balloon time was 19.7±14.2 min. Conclusions The distal radial approach is feasible and safefor primary PCI in selected patients with AMI.The application of the dTRA may serve as a less invasive strategy for the treatment of patients with AMI.

scholarly journals Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

2019 ◽  
Vol 11 (7) ◽  
pp. 710-713 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Samir Sur ◽  
David J McCarthy ◽  
Brian Snelling ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Hospital Costs ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Complication Rates ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Patient Demographics

BackgroundThe transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.ObjectiveTo report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.MethodsA retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.Results85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.ConclusiondTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

scholarly journals Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

2020 ◽  
Vol 22 (Supplement_F) ◽  
pp. F23-F29
Author(s):  
Stepan Jirous ◽  
Ivo Bernat ◽  
David Slezak ◽  
Roman Miklik ◽  
Richard Rokyta
Keyword(s):  
Radial Artery ◽  
Duplex Ultrasound ◽  
Artery Occlusion ◽  
Duplex Ultrasonography ◽  
Transradial Approach ◽  
Local Complications ◽  
Compression Time ◽  
First Choice ◽  
Same Day Discharge ◽  
Radial Artery Occlusion

Abstract The transradial approach is recommended as a first choice in coronary catheterizations and interventions, for among other reasons, the reduction in the number of local complications. A head-to-head comparison of the reverse Barbeau test (RBT) and duplex ultrasonography (DUSG) for the detection of post-procedural radial artery patency and occlusion has not yet been evaluated. In 500 patients from our same-day discharge program (age 65 ± 9.4 years, 148 women), radial artery patency and occlusion, compression time, haematomas, and other local complications were evaluated. Radial artery patency was confirmed in 495 patients (99.0%), and complete radial artery occlusion (RAO) was detected in 2 (0.4%) patients using both methods. In 3 patients (0.6%), the RBT was negative, while incomplete RAO was detected by DUSG. Superficial haematomas (˃ 5 but ≤10 cm) were found in 27 (5.4%) patients. There were no other local complications. Detection of radial artery patency and occlusion using the RBT and DUSG was comparable. The incidence of RAO in our study was extremely low. Thanks to its simplicity, the RBT has the potential to be used as the first method of detection of radial occlusion after coronary catheterizations.

Transradial access for neurointerventions: management of access challenges and complications

2019 ◽  
Vol 12 (1) ◽  
pp. 82-86 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Eric C Peterson
Keyword(s):  
Radial Artery ◽  
Randomized Trials ◽  
Endovascular Procedures ◽  
Anatomical Variations ◽  
Artery Occlusion ◽  
Morbidity And Mortality ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
The Common ◽  
Catheter Knots

BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

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