Transradial Approach versus Anatomical  Snuff Box Distal Radial Access for Coronary Procedures

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

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Left Radial Access Is Preferable to Right Radial Access for the Diagnostic or Interventional Coronary Procedures: A Meta-Analysis Involving 22 Randomized Clinical Trials and 10287 Patients

PLoS ONE ◽

10.1371/journal.pone.0078499 ◽

2013 ◽

Vol 8 (11) ◽

pp. e78499 ◽

Cited By ~ 14

Author(s):

Xiaogang Guo ◽

Jie Ding ◽

Yue Qi ◽

Nan Jia ◽

Shaoli Chu ◽

...

Keyword(s):

Clinical Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Radial Access ◽

Coronary Procedures

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CRT-100.88 Feasibility And Complications Of Left Versus Right Transradial Approach For Percutaneous Coronary Procedures

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.01.079 ◽

2018 ◽

Vol 11 (4) ◽

pp. S25

Author(s):

Yassir M. El haddad ◽

Hussein Heshmat Kassem ◽

Mohamed Abdel Meguid Mahdy ◽

Assem Abdel Aziz Hashad

Keyword(s):

Transradial Approach ◽

Percutaneous Coronary ◽

Coronary Procedures

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Transradial approach (left vs right) and procedural times during percutaneous coronary procedures: TALENT study

American Heart Journal ◽

10.1016/j.ahj.2010.10.003 ◽

2011 ◽

Vol 161 (1) ◽

pp. 172-179 ◽

Cited By ~ 89

Author(s):

Alessandro Sciahbasi ◽

Enrico Romagnoli ◽

Francesco Burzotta ◽

Carlo Trani ◽

Alessandro Sarandrea ◽

...

Keyword(s):

Transradial Approach ◽

Percutaneous Coronary ◽

Coronary Procedures

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TCT-425 Rotterdam Radial Access Research: Radial Artery Access Evaluation After Coronary Procedures With Very High Resolution Ultrasound; The Puncture’s Footprint

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.440 ◽

2015 ◽

Vol 66 (15) ◽

pp. B173

Author(s):

Jurgen Ligthart ◽

Karen T. Witberg ◽

Francesco Costa ◽

Marco Valgimigli ◽

Nicolas M. Van Mieghem

Keyword(s):

High Resolution ◽

Radial Artery ◽

Radial Access ◽

Coronary Procedures ◽

Very High

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Is the Complication Rate of Ulnar and Radial Approaches for Coronary Artery Intervention the Same?

Angiology ◽

10.1177/0003319717703226 ◽

2017 ◽

Vol 68 (10) ◽

pp. 919-925 ◽

Cited By ~ 5

Author(s):

Xile Bi ◽

Qingsheng Wang ◽

Defeng Liu ◽

Quan Gan ◽

Li Liu

Keyword(s):

Coronary Artery ◽

Odds Ratio ◽

Primary Outcome ◽

Arterial Occlusion ◽

Ulnar Artery ◽

Diameter Ratio ◽

Transradial Approach ◽

Single Procedure ◽

Single Center Study ◽

Coronary Procedures

We compared the clinical outcomes of patients who underwent coronary artery intervention by the transulnar and transradial artery approaches. In this 1 year, single-center study, patients were randomized to either a radial artery (RA) or ulnar artery (UA) group. Of 538 patients, the primary outcome, arterial occlusion of a forearm artery, occurred in 21 of 225 patients in the RA group compared to 6 of 220 patients in the UA group (9.3% vs 2.7%, P = .007). The rate of arterial occlusion was significantly lower following ulnar access compared to radial (odds ratio [OR] = 3.85, P = .006). A higher risk of occlusion was associated with repeated procedures rather than a single procedure (OR = 5.14, P = .003), smoking (OR = 2.39, P = .04), and arterial to sheath diameter ratio of ≤1 (OR = 2.62, P = .03). However, the disadvantage of UA was an increase of incidence of hematomas (13.2% vs 5.8%, P = .01) and symptoms of discomfort (15.5% vs 5.8%, P = .002). In conclusion, the transulnar strategy proved to be noninferior to the transradial approach for coronary procedures ( ClinicalTrials.gov Identifier: NCT01979627).

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The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access)

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.117.005753 ◽

2017 ◽

Vol 10 (11) ◽

Cited By ~ 17

Author(s):

Maarten A.H. van Leeuwen ◽

Maurits R. Hollander ◽

Dirk J. van der Heijden ◽

Peter M. van de Ven ◽

Kim H.M. Opmeer ◽

...

Keyword(s):

Radial Access ◽

Coronary Procedures

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Outcome off Primary Coronary Angioplasty by Radial Route: Study on 100 Cases

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/06 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr. Dilip Ratnani ◽

Dr. Rekha Ratnani

Keyword(s):

Hospital Stay ◽

Radial Artery ◽

Bleeding Complications ◽

Access Site ◽

Transfemoral Approach ◽

Artery Cannulation ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Radial Access ◽

Coronary Procedures

Recently radial artery is being used as a vascular access route for coronary procedures. Primary angioplasty with transfemoral procedure is associated with high access site bleeding complications due to use of potent antiplatelets and anticoagulants therefore radial access should be preferred if the operators are experienced and familiar with the technique. Methods: Total 100 pa‡…tients were included in the study in which procedure was performed by the trans radial route. All routine laboratory investigations were performed. Support of a temporary pacemaker was kept ready. All patients were prepared according to the Cardiac Catheterization Laboratory Standards. Radial artery cannulation was performed. Results: 100 patients were included in the study selected for radial route. Mean age of the patients who underwent primary CAI was 59±8.4. The most affected artery in the as shown angiography was Left anterior descending (58%) followed by Right coronary artery (41%). Least affected artery was left main (6%) and Ramus intermedius (6%). Mean of diseased vessels was 1.34 ± 1.25. Crossover from radial to femoral route was done on 5 patients of which 2 patients were having radial artery anomaly and in 3 patients arterial puncture was not successful. Mean hospital stay of the patients after procedure was 6.8 ± 2.1. Conclusion: transradial approach for coronary procedures is a safe technique and gives similar clinical results to transfemoral access. Complications at the radial access site are negligible. Length of hospital stay, time to mobilisation and cost all are reduced in the transfemoral approach.

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