Impact of percutaneous invasive coronary procedures using a radial approach on endothelial function of radial artery

Abstract Background Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago. The trans-ulnar approach is as safe and effective as the trans-radial approach for coronary angiography and intervention. Aim This study’s aim was to assess the feasibility and safety of the trans-ulnar approach in coronary procedures as a preliminary experience for operators experienced in trans-radial approach with no/minimal trans-ulnar approach experience at an Egyptian center. Results Vascular access in 120 patients was selected randomly for coronary angiography and angioplasty—80 through radial and 40 through ulnar approach. Patients were examined for local complications and Doppler evaluation to both radial and ulnar arteries a day after the procedure was done. Ulnar approach success was 82.5% versus 93.7% in the radial group; failure of ulnar artery puncture was the only cause of crossover in the ulnar group, while occurrence of persistent spasm was the leading cause of crossover in the radial group followed by radial artery tortuosity. The procedure time of coronary angiography and percutaneous coronary intervention of the ulnar group was significantly higher than that of the radial group (P value = 0.011 and 0.034, respectively). The mean caliber of the right ulnar artery was 2.45 ± 0.38, slightly larger than that of the radial artery 2.33 ± 0.38 at the level of the wrist, but this difference was statistically non-significant. Conclusion Our study demonstrated that ulnar access with experienced radial operators and in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complications. Bearing in mind its high success rate, it can be used when a radial artery is not useful for the catheterization or as a default approach on the expense of slightly longer procedural time.

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CRT-173 Feasibility and Safety of Repeat Radial Artery Route for Coronary Procedures

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2014.01.076 ◽

2014 ◽

Vol 7 (2) ◽

pp. S31

Author(s):

Janaswamy Vibhav Sri Narayana ◽

Maddury Jyotsna ◽

S. Shivaramakrishna

Keyword(s):

Radial Artery ◽

Coronary Procedures

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Diagnostic and Interventional Coronary Procedures by the Distal Radial Artery in the Anatomical SnuffBox: A Real World Analysis

Journal of Cardiovascular Diseases & Diagnosis ◽

10.4172/2329-9517.1000337 ◽

2018 ◽

Vol 06 (05) ◽

Author(s):

Luiz Antonio Gubolino ◽

Joao Felipe Barros de Toledo ◽

Pablo Tome Teixeirense ◽

Antoninha Marta LA Bragalha ◽

Idiberto Jose Zotarelli Filho

Keyword(s):

Radial Artery ◽

Real World ◽

Coronary Procedures ◽

Distal Radial Artery

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Radial Artery Anomalies and Subsequent Impact on Transradial Coronary Procedures—A Single Centre Experience

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.423 ◽

2012 ◽

Vol 21 ◽

pp. S170

Author(s):

R. Szirt ◽

W. Petrushnko ◽

A. Lee ◽

T. David ◽

P. Shetty

Keyword(s):

Radial Artery ◽

Single Centre ◽

Single Centre Experience ◽

Coronary Procedures

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Hand Laser Perfusion Imaging to Assess Radial Artery Patency: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm7100319 ◽

2018 ◽

Vol 7 (10) ◽

pp. 319 ◽

Cited By ~ 1

Author(s):

Ciro Indolfi ◽

Francesco Passafaro ◽

Sabato Sorrentino ◽

Carmen Spaccarotella ◽

Annalisa Mongiardo ◽

...

Keyword(s):

Radial Artery ◽

Perfusion Imaging ◽

Diagnostic Testing ◽

Area Under The Curve ◽

Diagnostic Technique ◽

Artery Occlusion ◽

Before And After ◽

Coronary Procedures ◽

Transradial Catheterization ◽

Artery Perfusion

Objectives: To test a novel diagnostic technique to assess radial artery perfusion after transradial catheterization. Background: Despite being mostly asymptomatic, radial artery occlusion (RAO) is not a benign complication, and its diagnosis is frequently missed because it requires time-consuming diagnostic testing. We developed a novel operator-independent diagnostic test to assess RAO after coronary procedures through a transradial access (TRA) by means of hand Laser Perfusion Imaging (LPI). Methods: One hundred patients were evaluated before and after TRA by means of the LPI. A radial perfusion index (RPI) was calculated as the ratio between the total perfusion measured during ulnar occlusion and total basal perfusion. Vascular Duplex scan (VDS) was used as the standard of reference to assess the artery patency. Results: LPI correctly identified RAO in 100% of cases. Post-procedural RPI was 0.89 ± 0.13 in patients with radial patency vs. 0.15 ± 0.04 in patients with RAO (p < 0.001). In line with these results, ROC analysis showed an excellent diagnostic performance of the LPI, that correctly identified all RAO cases (Area Under the Curve, AUC = 1.0; p < 0.001), with an optimal diagnostic cutoff at 0.2 RPI. Conclusions: LPI is a reliable diagnostic technique for RAO, offering the advantages of being quick and simple to perform.

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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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Anomalous Medial Branch of Radial Artery: A Rare Variant

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.98 ◽

2016 ◽

Vol 59 (3) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

Surbhi Wadhwa ◽

Vandana Tomar

Keyword(s):

Radial Artery ◽

Anatomical Variations ◽

Medial Branch ◽

Normal Pattern ◽

Access Site ◽

Capillary Vessel ◽

Radial Forearm ◽

Coronary Procedures ◽

Technical Failures ◽

Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

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Coronary Procedures by Left vs. Right Transradial Approach in Bangladeshi Diabetic Population

University Heart Journal ◽

10.3329/uhj.v11i1.27596 ◽

2016 ◽

Vol 11 (1) ◽

pp. 26-29

Author(s):

Saidur Rahman Khan ◽

CM Shaheen Kabir

Keyword(s):

Randomized Study ◽

Diabetic Patients ◽

Radial Approach ◽

Diffuse Disease ◽

Guide Catheter ◽

Contrast Volume ◽

Single Operator ◽

Diabetic Population ◽

Coronary Procedures ◽

Diagnostic Catheter

Background: Radial arterial approach is the usual option for coronary procedures in our hospital. Our aim was to evaluate the safety and efficacy of left radial approach (LRA) compared with right radial approach (RRA) for coronary procedures.Methods: This study is a single centre, single operator randomized study. Only diabetic patients more than 18 years old with bilateral normal allens test requiring coronary procedures (CAG and PCI) were included in this study. Study period was since January, 2011 to February, 2012. Primary PCI were excluded from this study. The patients were randomized to LRA or RRA arm for coronary procedures. Primary endpoint for diagnostic CAG was contrast volume and fluroscopy time and secondary endpoint was the prevalence of high grade subclavian tortuosity and number of diagnostic catheters used. Size of the conventional guide catheter (5 or 6 F) was compared in both arms irrespective of left or right coronary PCI.Results: Total 512 diabetic patients were enrolled for CAG and equally divided into LRA (256 patients) or RRA (256 patients) arms. Total 290 PCI was performed (145 LRA and 145 RRA). In CAG, LRA arm showed significantly lower fluroscopy time (p = 0.006) and contrast volume (p= 0.005) though more use of double diagnostic catheter (5 F TIG and JR) was present in LRA group. In PCI, RRA arm needed signicantly more 5 F guide catheter (p=0.001). Subclavian tortuosity were more observed in female RRA group.Conclusions: In diabetic population, CAG by left radial approach was superior to right in terms of amount of contrast and fluroscopy time. Subclavian tortuousity was more observed in right and especially more in female. In PCI, 6 F conventional guide catheters were commonly used in both approache though 5 F guide catheter were used more in right radial approach due to extreme subclavian tortuousity and diffuse disease. Dedicated sheathless guide catheter may resolve this issue.University Heart Journal Vol. 11, No. 1, January 2015; 26-29

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Effects of topical medications on radial artery spasm in patients undergoing transradial coronary procedures

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2016-003152 ◽

2016 ◽

Vol 14 (10) ◽

pp. 2-8 ◽

Cited By ~ 1

Author(s):

Elizabeth Curtis ◽

Ritin Fernandez ◽

Astin Lee

Keyword(s):

Radial Artery ◽

Coronary Procedures ◽

Topical Medications

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Abstract 17406: Early Experience With Ultrasound Guided Distal Trans-Radial Access in the Anatomical Snuffbox in Coronary Angiography and Intervention

Circulation ◽

10.1161/circ.138.suppl_1.17406 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Sangyeub Lee ◽

Woong-su Yoon ◽

Daehwan Bae ◽

Min Kim ◽

Sang Min Kim ◽

...

Keyword(s):

Coronary Angiography ◽

Success Rate ◽

Radial Artery ◽

Early Experience ◽

Coronary Intervention ◽

Ultra Sound ◽

Potential Candidate ◽

Ultrasound Guided ◽

Radial Approach ◽

Radial Access

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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