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

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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CUTOFF VALUE OF THE SHEATH-TO-ARTERY RATIO FOR RADIAL ARTERY OCCLUSION IN PATIENTS UNDERGOING TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTIONS USING SHEATHLESS GUIDING CATHETERS FOR ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31845-x ◽

2018 ◽

Vol 71 (11) ◽

pp. A1304

Author(s):

Tsuyoshi Isawa ◽

Kazunori Horie ◽

Naoto Inoue

Keyword(s):

Acute Coronary Syndrome ◽

Radial Artery ◽

Artery Occlusion ◽

Percutaneous Coronary Interventions ◽

Cutoff Value ◽

Coronary Syndrome ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Radial Artery Occlusion

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Safety and efficacy of different arterial pressure bandages following percutaneous coronary interventions from radial access: preliminary data of the RAD-PRESS trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2503 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Nemeth ◽

F Nowotta ◽

Z Ruzsa ◽

T Szuk ◽

D Becker ◽

...

Keyword(s):

Radial Artery ◽

Cost Effective ◽

Artery Occlusion ◽

Percutaneous Coronary Interventions ◽

Puncture Site ◽

Hematoma Formation ◽

Radial Access ◽

Compression Time ◽

Percutaneous Coronary ◽

Radial Artery Occlusion

Abstract Background The overwhelming majority of diagnostic coronary angiographies and percutaneous coronary interventions (PCIs) are performed via radial access as recommended by the current European revascularization guidelines. Using dedicated pressure bandages for the radial access site in high-volume centres can be a significant part of the budget of catheterization laboratories, therefore we developed a cost-effective pressure bandage utilizing wrapped empty glass vials of intravenous medications. Furthermore, compression time of the radial puncture site following PCI is a predictor of radial artery occlusion, therefore shortening the period of compression to as short as possible is feasible. Purpose Our aim was to validate efficacy and safety of our cost-effective pressure bandage by comparing it to two dedicated devices, as well as reducing length of compression to as short as possible. Methods We designed the RAD-PRESS trial, major inclusion criteria of which were first puncture of a radial artery with a diameter greater than 1.8mm, PCI performed as per guidelines utilizing a 6 French guiding catheter and age below 80 years. Patients were then randomized to receive one of three pressure bandages: the glass vial, Seal-One or the gold standard TR-band. Release of pressure was performed as fast as possible in 10-minute steps, and guided by pulse oximetry. Hematoma formation was thoroughly checked for all patients and categorized using the Easy scale. Radial artery patency was investigated by ultrasound 24 hours after final removal of the bandage. The data of 40 patients of every group was analysed. Results Population characteristics were similar among the groups. Length of compression time (126±10, 142±11 and 144±11 mins for Vial, Seal-One and TR-band, respectively, p>0.05), hematoma formation (Easy Grade 1 in 17.5%, 15.0% and 10.0%, Easy Grade 2 in 5.0%, 7.5% and 7.5% for Vial, Seal-One and TR-band, respectively, all p>0.05) were not significantly different among the groups. Radial artery occlusion occurred in only 2 patients (Vial and TR-Band groups), accounting for 1.7% of the cases. Conclusions The cost-effective wrapped vial strategy to compress the radial puncture site was comparable to both Seal-One and the gold standard TR-band regarding safety and efficacy. Furthermore, compression time could be safely shortened to approximately 2.5 hours. Funding Acknowledgement Type of funding source: None

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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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PP-068 [AJC » Percutaneous coronary interventions] The Effects of the Radial Coronary Angiography on the Radial Artery Diameter

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.03.207 ◽

2017 ◽

Vol 119 (8) ◽

pp. e79-e80

Author(s):

Emre Özçalık ◽

Alp Aydınalp

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary

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Should We Use Staged or Ad-Hoc Approach in Percutaneous Coronary Interventions Through Radial Artery to Avoid Radial Artery Spasm?

Erciyes Medical Journal ◽

10.14744/etd.2020.94752 ◽

2020 ◽

Author(s):

Gültekin Günhan Demir

Keyword(s):

Radial Artery ◽

Ad Hoc ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary

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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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