A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention.

Shinsuke Mori,Kenji Makino,Norihiro Kobayashi,Yasunari Sakamoto,Yoshiaki Ito,Masakazu Tsutsumi,Masahiro Yamawaki,Yohsuke Honda,Keisuke Hirano,Shigemitsu Shirai

doi:10.1155/2020/7342732

Abstract

Objectives To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported. Method Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups. Results The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study. Conclusion The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.

Highlights

Patients and procedural characteristics are shown in Table 1. e mean age was significantly higher in the Conventional puncture group (C group) than in the U group (74.1 ± 9.6 years vs. 70.4 ± 10.5 years, P 0.03). ere was no significant difference in the proportion of male gender, body mass index, the rate of diabetes mellitus, the rate of chronic kidney disease, the rate of dialysis, the use of left-handed access, sheath size, and the rate of percutaneous coronary interventions (PCI) between the two groups
7 cases were switched from conventional puncture to ultrasound-guided puncture, and procedures in all these cases were completed via ultrasound-guided distal transradial access (dTRA)
One patient had a chest pain due to a left anterior descending stenosis that was detected by coronary computed tomography angiography. e pulse of the bilateral distal radial artery was weak since the patient underwent coronary angiography (CAG) or PCI multiple times

Summary

Introduction

To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. E ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. One of the advantages of dTRA is the reduction of puncture site complications such as bleeding and radial artery occlusion (RAO) [1].

Objectives

Results

Conclusion