Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors

2017 ◽  
Vol 18 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Adam Zybulewski ◽  
Martin Edwards ◽  
Edward Kim ◽  
Francis S. Nowakowski ◽  
Rahul Patel ◽  
...  
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Effective Alternative ◽  
Bleeding Complications ◽  
Technical Success ◽  
Internal Radiation ◽  
Access Site ◽  
Technical Factors ◽  
Liver Embolization

Purpose Transulnar access (TUA) has been shown to be an effective alternative to transradial access (TRA) for coronary intervention. This study evaluates the safety and efficacy of TUA in patients undergoing visceral interventions in the setting of contraindication to TRA. Materials and Methods Patients who underwent visceral interventions via ulnar approach were included in the study. Outcome variables include technical success, access site and bleeding complications. Results From May 2014 to September 2016, TUA was attempted 17 times in 14 patients (mean age: 60 years; range: 27 to 81 years) for whom TRA was planned for visceral intervention, but contraindicated. Contraindication to TRA included Barbeau D waveform (n = 3), radial artery diameter <2 mm (n = 8), known radial loop (n = 2), high takeoff of the radial artery (n = 2), prior radial artery occlusion (RAO) (n = 1), and radiocephalic arteriovenous fistula (n = 1). Interventions included selective internal radiation therapy (SIRT) (n = 4), SIRT mapping (n = 2), chemoembolization (n = 6), renal embolization (n = 1) and bland liver embolization (n = 4). Technical success was achieved in 94.1% (16/17 cases) with the single failure attributed to an inability to cannulate the target vessel due to vessel tortuosity, requiring ipsilateral femoral crossover. There were no major access site or bleeding complications. Minor adverse events include two access site hematomas, which were successfully treated with conservative management. Conclusions TUA for visceral interventions is a safe and effective alternative to femoral approach when TRA is contraindicated.

Sheathless guiding catheter versus “slender” sheath/guiding catheter combination in acute coronary syndrome: a propensity-matched analysis of two downsized devices

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Isawa ◽  
K Horie ◽  
T Honda
Keyword(s):  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Coronary Syndrome ◽  
Radial Artery Occlusion ◽  
Transradial Pci ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Purpose We investigated the differences between a sheathless guiding catheter and a Glidesheath slender/guiding catheter combination regarding access-site complications in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods We enrolled consecutive 1108 patients undergoing transradial primary PCI for ACS at our hospital using either a 7.5-Fr sheathless guiding catheter (Sheathless group) or a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group); 1:1 propensity score matching was performed, and 718 subjects (359 in each group) were included in the propensity-matched sample. Results Compared with the Sheathless group, the Glidesheath group had significantly less frequent ultrasound-diagnosed radial artery occlusion at 30 days (Sheathless: 4.7% vs. Glidesheath: 1.4%, p=0.015). No significant differences were observed in severe radial spasm (Sheathless: 1.4% vs. Glidesheath: 2.0%, p=0.77) or access-site bleeding (Sheathless: 9.8% vs. Glidesheath: 8.6%, p=0.70). Conclusion Thus, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is clearly more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of radial artery occlusion in transradial PCI for ACS. “Sheathless” vs. “Glidesheath slender” Funding Acknowledgement Type of funding source: None

scholarly journals Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Wei-Chieh Lee ◽  
Chieh-Ho Lee ◽  
Wen-Jung Chung ◽  
Shu-Kai Hsueh ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Procedural Success

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

scholarly journals Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome

2020 ◽  
Vol 47 (4) ◽  
pp. 319-321
Author(s):  
Thomas J. Earl
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Raynaud Phenomenon ◽  
Hand Ischemia ◽  
Percutaneous Coronary ◽  
Esophageal Dysfunction ◽  
Radial Artery Occlusion ◽  
Digital Amputation

The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.

scholarly journals Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions

2021 ◽  
Vol 10 (10) ◽  
pp. 2204
Author(s):  
Oh-Hyun Lee ◽  
Ji Woong Roh ◽  
Eui Im ◽  
Deok-Kyu Cho ◽  
Myung Ho Jeong ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Radial Approach ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions ◽  
Radial Artery Occlusion

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

2021 ◽  
pp. 112972982110052
Author(s):  
Gianluca Rigatelli ◽  
Marco Zuin ◽  
Ramesh Daggubati ◽  
Dobrin Vassilev ◽  
Giovanni Zuliani ◽  
...  
Keyword(s):  
Radial Artery ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Case Control ◽  
Artery Occlusion ◽  
Case Control Studies ◽  
Access Site ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Background: A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. Objective: To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. Data sources: Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. Study eligibility criteria: Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. Study appraisal and synthesis methods: Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31–069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37–1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48–1.63, p = 0.001, I2 = 0%, respectively). Limitations: Only eight case-control studies met inclusion criteria Conclusion: This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

Low-molecular-weight-heparin in radial artery occlusion treatment: the LOW-RAO randomized study

2021 ◽  
Author(s):  
Matthaios Didagelos ◽  
Areti Pagiantza ◽  
Thomas Zegkos ◽  
Christos Papanastasiou ◽  
Konstantina Zarra ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Radial Artery ◽  
Low Molecular Weight Heparin ◽  
Controlled Trial ◽  
Randomized Study ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Low Molecular Weight ◽  
Open Label ◽  
Radial Artery Occlusion

Radial artery occlusion (RAO) is the commonest complication of transradial catheterization. There is no evidence-based therapy, in the frame of a randomized control study, for the treatment of RAO. The purpose of the LOW-RAO study is to question the hypothesis if low-molecular-weight heparin is effective in the treatment of RAO after transradial coronary catheterization (both angiography and percutaneous coronary intervention). It is a prospective, open label, randomized controlled trial that will randomize 60 patients with RAO, irrespective of symptoms, into two groups, one receiving anticoagulation with low-molecular-weight heparin and the other receiving no treatment. The primary end point is improvement in radial artery patency rate at 4 weeks after the procedure. Trial registration number: NCT04196309 (ClinicalTrials.gov)

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

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.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

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