Distal Trans-Radial Approach for Coronary Angiography and Percutaneous Coronary Interventions - Single-Centre Experience

Abstract Right distal transracial approach in the anatomical snuff box could reduce the probability of radial artery occlusion. Also, that approach allows a more comfortable hand position, especially in obese patients. We prospectively evaluated right distal transracial approach (DTRA) in patients treated trans-radially. Materials and methods: Prospective, observational, single centre study. Various relevant objectives were assessed, for example radial artery occlusion in the evaluated patients at discharge by ultrasonography, procedural success, time of scopy and time required for haemostasis. 57 eligible patients were included in the study. The mean age was 63 years, 63% men, and PCI was performed in 37% of patients. In all patients we used 6Fr radial sheaths, standard catheters and TR-band with verification after one hour, then within 30-minute intervals. Results: Procedural success was 89.5%, no patients had radial artery occlusion, two patients had a local hematoma remitted later, the medium time required for hemostasis was 83.5 minutes, no patients suffered ischaemia or any effect in right hand’s functions. Conclusion: Distal radial puncture seems feasible, safe and can be considered routinely.

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The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience

Acta Cardiologica ◽

10.1080/00015385.2019.1705584 ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Feyzullah Besli ◽

Fatih Gungoren ◽

Zulkif Tanriverdi ◽

Mustafa Begenç Tascanov ◽

Halil Fedai ◽

...

Keyword(s):

Unfractionated Heparin ◽

Radial Artery ◽

Artery Occlusion ◽

Cardiac Catheterisation ◽

High Dose ◽

Single Centre ◽

Single Centre Experience ◽

Radial Artery Occlusion

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Radial artery occlusion after primary percutaneous coronary interventions performed using different radial approaches

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2020-3s-33-42 ◽

2020 ◽

Vol 24 (3S) ◽

pp. 33

Author(s):

R. V. Akhramovich ◽

S. P. Semitko ◽

A. V. Azarov ◽

I. S. Melnichenko ◽

A. I. Analeev ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Radial Artery ◽

Artery Occlusion ◽

Percutaneous Coronary Interventions ◽

Radial Approach ◽

Coronary Syndrome ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Radial Artery Occlusion ◽

Approach Group

Aim. The analyses of radial artery patency during hospitalisation in patients with acute coronary syndrome after percutaneous coronary interventions were performed using three options of radial approaches, i.e. traditional, classical and dorsopalmar distal radial approaches.Methods. Patients (n = 178) with acute coronary syndrome on whom endovascular procedure by the traditional and two options of distal radial approach were performed met the entry criteria. The classical distal radial approach was performed within an anatomic snuffbox in 65 patients (36.5%), and the dorsopalmar type was performed in 29 patients (16.3%); the traditional radial approach was performed in 84 patients (47.2%). On completion of the percutaneous coronary interventions and final radial artery angiography, hemostasis was performed with bandage application for 6 h. From the 5th to the 7th day after intervention, examination, palpation and ultrasound duplex scan were performed in every patient.Results. Examination, palpation and ultrasound duplex scan performed from the 5th to 7th day after intervention revealed 3 cases (1.7%) of forearm radial artery occlusion (high type). All the 3 cases were in the traditional radial approach group. Access side radial artery occlusion (at the anatomical snuffbox and the dorsum of the plant [local type]) with saved blood supplement on the forearm was registered in the classical distal radial approach group in 4 cases (2.3%). There were no cases of access side radial artery occlusion in the dorsopalmar group.Conclusion. The use of the distal radial approach for primary percutaneous coronary intervention in patients with acute coronary syndrome definitely reduces the risk of radial artery occlusion of the forearm, whereas the dorsopalmar distal radial approach can be considered as a basic approach.Received 11 May 2020. Revised 31 May 2020. Accepted 3 June 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: S.P. Semitko, R.V. Akhramovich Data collection and analysis: R.V. Akhramovich, I.S. Melnichenko Drafting the article: R.V. Akhramovich Critical revision of the article: S.P. Semitko Final approval of the version to be published: R.V. Akhramovich, S.P. Semitko, A.V. Azarov, I.S. Melnichenko, A.I. Analeev, I.E. Chernyisheva, A.A. Tretyakov, D.G. Ioseliani

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

Journal of International Medical Research ◽

10.1177/0300060520954727 ◽

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.

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Expert reviews Radial artery occlusion after percutaneous coronary interventions – an underestimated issue

Advances in Interventional Cardiology ◽

10.5114/pwki.2013.38865 ◽

2013 ◽

Vol 4 ◽

pp. 353-361 ◽

Cited By ~ 1

Author(s):

Janusz Sławin ◽

Piotr Kubler ◽

Andrzej Szczepański ◽

Joanna Piątek ◽

Michał Stępkowski ◽

...

Keyword(s):

Radial Artery ◽

Artery Occlusion ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Radial Artery Occlusion

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Impact of Radial Compression Protocols on Radial Artery Occlusion and Hemostasis Time

10.21203/rs.3.rs-820946/v1 ◽

2021 ◽

Author(s):

Sachiko Takamatsu ◽

Nobuyuki Kagiyama ◽

Naohiko Sone ◽

Kiyotaka Tougi ◽

Shuichiro Yamauchi ◽

...

Keyword(s):

Radial Artery ◽

Odds Ratio ◽

Dual Antiplatelet Therapy ◽

Artery Occlusion ◽

Evidence Based ◽

Radial Compression ◽

Protocol Group ◽

Before And After ◽

Radial Artery Occlusion ◽

Time Required

Abstract Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidence-based protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, the amount and timing of deflation were fixed in the traditional protocol, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1,842 patients (71±10 years old, 77% male) were included. Compared with the traditional protocol group (n=1,001), the new protocol group (n=841) had a significantly lower rate of dual antiplatelet therapy (24% vs. 35%, p<0.001). The time required for complete hemostasis was approximately one-third with the new protocol (66±32 min vs. 190±16 min, p<0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p<0.001). After adjusting for covariates, the new protocol was associated with a shorter hemostasis time (odds ratio 0.01, p<0.001) and a reduced risk of RAO (odds ratio 0.09, p<0.001). Our new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.

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Lessons from transulnar access for repeat percutaneous coronary intervention after radial artery occlusion

Chinese Medical Journal ◽

10.1097/cm9.0000000000000737 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Xi-Le Bi ◽

Qing-Sheng Wang

Keyword(s):

Percutaneous Coronary Intervention ◽

Radial Artery ◽

Coronary Intervention ◽

Artery Occlusion ◽

Percutaneous Coronary ◽

Radial Artery Occlusion

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Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience

Cardiology ◽

10.1159/000517076 ◽

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

Objective: 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). Methods: 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. Results: 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 (<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%). Conclusion: 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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