Evaluation of radial artery endothelial functions in transradial coronary angiography according to different radial access sites.

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.

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Abstract 374: Trans-radial Access Angiography Learning Curve

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.374 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Julian Chan ◽

Rosanna Tavella ◽

John F Beltrame ◽

Matthew Worthley ◽

Sivabaskari Pasupathy ◽

...

Keyword(s):

Coronary Angiography ◽

Learning Curve ◽

Radial Artery ◽

Vascular Access ◽

Best Practice ◽

Femoral Access ◽

Coronary Syndrome ◽

Radial Access ◽

Increased Risk ◽

Radial Operators

Introduction: Radial artery access has been adopted widely around the world as standard best practice for coronary angiography with or without percutaneous coronary intervention. Radial artery access offers benefits in regard to reduced major bleeding, reduced hospital stay, fewer vascular complications, similar procedural times, patient preference and a mortality benefit in acute coronary syndrome/STEMI management. Despite transradial access being best practice, there has been a slow uptake of this technique amongst some cardiologists/interventionalists, particularly in the USA. This may partially be attributed to uncertainties regarding the learning curve and concerns regarding delaying treatment in STEMI if radial access fails. Methods: Using the data from the Coronary Angiography Database Of South Australia registry (CADOSA), we sought to determine the radial access failure rates for acute cases during transition from routine femoral access to routine radial access from 2012 to 2016, a period when the greatest transition in practice occurred. Data regarding initial vascular access, success or failure, and subsequent vascular access was prospectively recorded for all cases. Operators with at least a 70% rate of initial radial access were deemed to be established radial operators and acted as controls for operators transitioning from femoral access (at least 70% of cases) to radial access during the study period. Cases were further classified as elective, urgent (eg inpatient ACS) or emergency (eg STEMI). Results: There were 23 operators with sufficient volumes, responsible for 20,073 cath lab visits during the 5 year period studied. The overall radial access rate increased from 57% in 2012 to 78% in 2016. For operators transitioning from a default femoral access (76% of case) to a default radial access (75% of cases), the radial access failure rate for urgent and emergency cases was 3.7%, compared to 3.5% for experienced radial operators over the same period. Conclusion: Despite strong evidence of benefit for radial access angiography and intervention, compared to femoral access, some operators remain reluctant to transition. Utilising the CADOSA database, we observed a safe transition from femoral to radial access without an increased risk of access site failure for acute cases. Transition from femoral to radial access can be made safely by a range of clinicians managing acute cases.

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

European Heart Journal ◽

10.1093/eurheartj/ehz746.1113 ◽

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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Should the radial artery be used as a bypass graft following radial access coronary angiography: Table 1:

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt478 ◽

2013 ◽

Vol 18 (2) ◽

pp. 219-224 ◽

Cited By ~ 11

Author(s):

Lisa M. Lim ◽

Sean D. Galvin ◽

Mohamed Javid ◽

George Matalanis

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Bypass Graft ◽

Radial Access

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Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access

Journal of Clinical Medicine ◽

10.3390/jcm10174020 ◽

2021 ◽

Vol 10 (17) ◽

pp. 4020

Author(s):

Katarzyna Klimek ◽

Mateusz Świątek ◽

Konrad Klocek ◽

Michał Tworek ◽

Maciej Zwolski ◽

...

Keyword(s):

Coronary Angiography ◽

Radiation Exposure ◽

Radial Artery ◽

Statistical Difference ◽

Radiation Dosage ◽

Access Site ◽

Radial Access ◽

Baseline Characteristics ◽

The Right ◽

Left Radial Artery

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.

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Coronary Angiogram using Distal Radial Access: A Retrospective Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47895.14576 ◽

2021 ◽

Author(s):

S Lalitha ◽

Vijay Sai ◽

. Siddarth

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Age Distribution ◽

Ulnar Artery ◽

Safe Alternative ◽

Exact Test ◽

Dose Area Product ◽

Radial Access ◽

Area Product ◽

Randomised Controlled

Introduction: Transradial access has become gold standard for percutaneous coronary catheterisation procedures. As the learning curve overcomes, safe alternative access sites such as Distal Radial Artery (DRA), ulnar artery have been tried. Aim: The aim of this study was to generate best evidence for using right DRA for coronary angiography. Materials and Methods: In this retrospective study, a novel route in addition to radial artery was studied. A total of 150 cases who underwent the angiogram by the DRA technique were included in the study, preserving the radial artery for various procedures. DRA was punctured in anatomical snuffbox by standard techniques and coronary angiography was performed. The evaluated parameters included the characteristics of patients (gender and age distribution), blood pressure (systolic and diastolic), mean arterial pressure, flouro time, puncture time, Dose Area Product (DAP) and cumulative air kerma. Fisher’s-exact test was used to find out the association between the gender, hypertension, diabetes and the success of puncture. Results: There was 93.4% successful puncture rate for distal radial access. There was no influence of age on the success of puncture. The association of success of puncture with gender, hypertension and diabetes was not statistically significant. Conclusion: This study presents that the distal radial approach is feasible and relatively safe. Further randomised controlled trials may be required to establish this relatively new approach as the standard care.

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Can the Radial Artery be Used as a Bypass Graft Following Radial Access Coronary Angiography

Heart Lung and Circulation ◽

10.1016/j.hlc.2013.03.015 ◽

2013 ◽

Vol 22 (6) ◽

pp. 459-460

Author(s):

Mohamed Javid ◽

Sean D. Galvin ◽

Casey Lo ◽

Lisa Lim ◽

Balamurali Srinivasan ◽

...

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Bypass Graft ◽

Radial Access

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Distal transradial access for coronary angiography and interventions in everyday practice: data from the TRIANGLE Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2453 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Schenke ◽

A Viertel ◽

R Prog ◽

N Joghetaei ◽

T Matthiesen ◽

...

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Dorsal Side ◽

High Rate ◽

Puncture Site ◽

Total Occlusion ◽

Coronary Syndrome ◽

Radial Access ◽

Transradial Access ◽

Crossover Rate

Abstract Background Transradial access has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally on the dorsal side of the hand in the area of the anatomical snuffbox has been developed. Purpose With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal transradial access (dTRA) and assess the rate of radial artery occlusion (RAO). As an exploratory endpoint, we compared peri-interventional data between right- and left-radial access and differences between the true anatomical snuffbox (SB) and the distal- dorsal (DD) puncture site. Methods Between December 2018 and May 2019 we included all patients into this registry with a planned CAG or PCI via dTRA in three cardiology centers in Germany. Procedural data, puncture success, crossover rate and complications were registered. We examined proximal and distal radial artery patency by ultrasound within 48 h after removal of compression device. Results A total of 327 patients were enrolled (mean age: 69 years, male: 69%), in 5 cases bilateral distal puncture was performed, puncture success was high (N=316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal (2/332) and distal (3/332) RAO was low. Major complications were not encountered. The comparison between SB and DD site and left- and right radial access showed no significant differences (see table). The indication for CAG in 50% of the population was acute coronary syndrome, including 28 patients with ST elevation myocardial infarction (8.4%). Overall PCI rate was 48%. PCI cases did not demonstrate a crossover rate higher than in CAG. PCI on chronic total occlusion (CTO) was performed in 16 cases including bilateral dTRA. Conclusion Coronary angiography and interventions via dTRA can be performed with a high rate of success and safety. This data suggests a reduced rate of RAO compared to previous reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results. Funding Acknowledgement Type of funding source: None

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