Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review

Purpose: Radial artery occlusion (RAO) is one of the common complications after coronary intervention via the conventional radial artery approach. The purpose of the study was to explore the safety and feasibility of retrograde recanalization of the occluded radial artery via a distal radial artery (DRA) approach. Methods: Combined with the practice of our centre and a literature review, we summarized the procedure of retrograde recanalization of RAO, success rate, and complications. Results: A total of 14 of 15 patients with 15 pieces of occluded radial arteries were successfully recanalized via the DRA in our centre. In the 15 occluded vessels, 11 vessels (73.3%) had total occlusion and 4 vessels (26.7%) had functional occlusion. Four of 15 occluded vessels were acute occlusions. Two acute RAOs were only treated with aspiration via sheath, 11 RAOs with balloon angioplasty, and 2 RAOs with both, respectively. In 6 patients, cardiac catheterization was carried out via the DRA after recanalizing the RAO. A total of 10 studies reporting the results of recanalization of RAO via the DRA were systematically retrieved in the present study. In 3 case series, the number of cases was more than 5, and the success rate of recanalization was more than 85.7%. Two studies reported complications, including dissection in one case, hematoma in 2 cases, and pain in the forearm during angioplasty. Conclusions: Recanalization of the occluded radial artery via the DRA was safe and effective. When repeat cardiac catheterization was required, recanalization of the RAO and subsequent coronary angiography or intervention through the ipsilateral radial artery approach was feasible.

The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients’ transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05 ), angiography success rate (97.3% vs. 95.1%, P > 0.05 ), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05 ) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05 ), puncture time (22.42 vs. 31.02 min, P < 0.05 ), and complications (3.57% vs. 9.03%, P < 0.05 ) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group ( P < 0.05 ). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Reference diameter and characteristics of the distal radial artery based on ultrasonographic assessment

Background/Aims: While distal radial artery (DRA) access is increasingly being used for diagnostic coronary angiography, limited information is available regarding DRA size. We aimed to determine the DRA reference diameters of Korean patients and identify the predictors of DRA diameter < 2.3 mm.Methods: The outer bilateral DRA diameters were assessed using a linear ultrasound probe in 1,162 consecutive patients who underwent transthoracic echocardiography. The DRA diameter was measured by the perpendicular angle in the dorsum of the hand, and the average values were compared by sex. DRA diameter < 2.3 mm was defined as unsuitable for routine diagnostic coronary angiography using a 5 Fr introducer sheath.Results: The mean DRA diameters were 2.31 ± 0.43 mm (right) and 2.35 ± 0.45 mm (left). The DRA was smaller in women than men (right: 2.15 ± 0.38 mm vs. 2.43 ± 0.44 mm, p < 0.001; left: 2.18 ± 0.39 mm vs. 2.47 ± 0.45 mm, p < 0.001). The DRA diameter was approximately 20% smaller than the radial artery diameter. A total of 630 (54.2%) and 574 (49.4%) patients had DRA diameter < 2.3 mm in the right and left hands, respectively. Female sex, low body mass index (BMI), and low body surface area (BSA) were significant predictors of DRA diameter < 2.3 mm.Conclusions: We provided reference DRA diameters for Korean patients. Approximately 50% of the studied patients had DRA diameter < 2.3 mm. Female sex, low BMI, and low BSA remained significant predictors of DRA diameter < 2.3 mm.