Coronary catheterization via distal transradial access in patient with superficial radial artery: a case report

Abstract Background The routine radial artery (RA) puncture may fail when anatomical variation of the RA is encountered. Superficial radial artery (SRA) is one of the anatomic variants of the RA, with the incidence of about 1 to 1.5%. Recently, distal transradial access (dTRA) has emerged as a novel approach for coronary catheterization (CC), but performing CC through dTRA in patient with SRA has never been reported. Case presentation A 57-year-old male was admitted to hospital due to intermittent chest pain for 4 days. He was diagnosed with unstable angina pectoris and planned to receive coronary angiography (CAG). Before the operation, the existence and course of SRA were confirmed by palpation and ultrasonography with color Doppler. We marked the puncture site under the guidance of ultrasonography and successfully performed CC through the dTRA during patient’s hospitalization. Conclusions As far as we know, this is the first report that presents a case of SRA and percutaneous coronary intervention (PCI) treatment in which was successfully performed through dTRA. It is safe and feasible to perform CC via dTRA in case of SRA, and dTRA seems to be the preferred access.

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Feasibility and Safety of Distal Radial Artery Access in Anatomical Snuffbox for Coronary Angiography and Coronary Intervention

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i1.2402 ◽

2020 ◽

Vol 18 (2) ◽

pp. 259-262

Author(s):

Arun Maskey ◽

Birat Krishna Timalsena ◽

Sheikh Aslam ◽

Rabindra Pandey ◽

Madhu Roka ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Angiography ◽

Radial Artery ◽

Vascular Access ◽

Coronary Intervention ◽

Pain Rating ◽

Coronary Interventions ◽

Transradial Access ◽

Percutaneous Coronary ◽

Distal Radial Artery

Background: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox.Methods: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. Results: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure.Conclusions: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention. Keywords: Cardiac catheter; coronary angiography; feasibility studies; percutaneous coronary intervention; radial artery; vascular access device

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

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01890-1 ◽

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.

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CORONARY CATHETERIZATION

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.05.317 ◽

2018 ◽

Vol 25 (05) ◽

pp. 735-739

Author(s):

Aamir Siddique ◽

Rehan Riaz ◽

Imran Javaid

Keyword(s):

Radial Artery ◽

Coronary Intervention ◽

Cross Sectional Study ◽

Radial Pulse ◽

Cross Sectional ◽

Local Study ◽

Coronary Catheterization ◽

Alternative Approach ◽

Percutaneous Coronary ◽

Study Results

Introduction: In recent years the trans-radial approach has been increasinglyemployed as an alternative approach to percutaneous coronary intervention. Loss of radial pulsemay lead to ischemic symptoms like pain in hand, claudication etc. There is a lack of local dataregarding complication associated with trans-radial coronary catheterization. Therefore, thereis need for local study to find out the frequency of complications associated with trans-radialapproach. Objectives: To determine the frequency of loss of radial pulse in patients undergoingtrans-radial coronary catheterization. Design: Cross sectional study. Setting: Department ofCardiology, Jinnah Hospital, Lahore. Period: From 3rd June 2014 to 2nd December 2014.Methodology: All 325 cases fulfilling the inclusion/exclusion criteria undergoing coronarycatheterization were included in the study. Results: A total of 325 patients, both male and femalewith positive Allens test, undergoing Trans-radial angiography for intervention were included.Loss of radial pulse was evaluated clinically at four weeks follow up.In our sampled population,mean age was 57.01 ± 6.8 years and 240 patients (73.8%) were male while 85 patients (26.2%)were female. Only 14 patients (4.3%) out of 325 had loss of radial artery pulse while remaining311 patients (95.7%) didn’t have loss of radial artery pulse. There was found no effect of genderon outcome i.e. loss of radial pulse but older age made a person prone to loss of radial pulse.Conclusion: It is concluded that the frequency (percentage) of loss of radial pulse is quite low(4.3%) in our patients undergoing trans-radial coronary catheterization.

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Comparison of Radial Artery Occlusion Following Transradial Access for Percutaneous Coronary Intervention Using Sheath-based versus Sheathless Technique

Scientific Reports ◽

10.1038/s41598-018-30462-1 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 2

Author(s):

Ala Mohsen ◽

Musab Alqasrawi ◽

Ghanshyam Palamaner Subash Shantha ◽

Chris DeZorzi ◽

Sidakpal Panaich

Keyword(s):

Percutaneous Coronary Intervention ◽

Radial Artery ◽

Coronary Intervention ◽

Artery Occlusion ◽

Transradial Access ◽

Percutaneous Coronary ◽

Radial Artery Occlusion

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Distal Transradial Access For Percutaneous Coronary Intervention And Coronary Angiography : Advances In Interventional Cardiology

KYAMC Journal ◽

10.3329/kyamcj.v11i3.49875 ◽

2020 ◽

Vol 11 (3) ◽

pp. 154-157

Author(s):

SM Taslim Yusuf Tamal ◽

Steven Huang ◽

Md Saiful Islam ◽

SK Yunus Ali

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Angiography ◽

Radial Artery ◽

Interventional Cardiology ◽

Coronary Intervention ◽

Comfort Level ◽

New Technique ◽

Transradial Access ◽

Number Of Patients ◽

Percutaneous Coronary

Since its' introduction in 2017, Distal Transradial Access (dTRA) has shown it's advantages over conventional Transradial Approach in terms of risk with Radial Artery Occlusion (RAO) and with the comfort level for both the patient and operator. A large number of patients requiring subsequent intervention gets much benefit with this new technique of Radial Artery (RA) preservation, as it is a refinement of the conventional approach. On the other hand, the most challenging part it has is the supreme level of expertise for a successful puncture for the advancement with the procedure. Still, this new technique has been obtained by the Interventionists world wide with the simultaneous study on it to make the distal transradial access as a default access site for routine Coronary Angiography (CAG) and Percutaneous Coronary Intervention (PCI). For evaluation with the real world feasibility and safety along with the comfort for both the operator and patient, this study has been conducted. KYAMC Journal Vol. 11, No.-3, October 2020, Page 154-157

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

The Journal of Vascular Access ◽

10.1177/11297298211005256 ◽

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.

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Feasibility and Outcomes of Percutaneous Coronary Intervention to Radial Artery Bypass Graft Stenoses and General Characteristics of Radial Graft Failure: Insights From a Multicentre PCI Registry

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.478 ◽

2021 ◽

Vol 30 ◽

pp. S307-S308

Author(s):

G. Hamilton ◽

D. Dinh ◽

O. Farouque ◽

J. Raman ◽

J. Yeoh ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Radial Artery ◽

Graft Failure ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Intervention ◽

Artery Bypass Graft ◽

Percutaneous Coronary

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.366 ◽

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.

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