Abstract
Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.
Highlights
Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route
Under local anesthetic, we performed the puncture with a 21-gauge needle with a 30 ̊ - 45 ̊ angle medial to laterally and introduced a straight 0.018-inch guide wire with a soft, flexible proximal part and rigid distal part, followed by the introduction of a 5/6 F for radial hydrophilic sheath according to procedure for distal radial access into the radial artery (Figure 4(a) and Figure 4(b))
To avoid the possible discomfort that may arise from prolonged procedure, the start of vascular access of traditional right radial (TRA) right hand was kept along the side of the body with fingers and wrist kept in dorsi flexed state with a support in supine position (Figure 6) but during distal trans radial artery (DTRA) patient’s hand was kept in semi prone position
Summary
Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Coronary Angiogram (CAG) & Percutaneous Coronary Intervention (PCI) are important interventions to diagnose and treat for atherosclerosis Coronary Artery Disease (CAD). It can be performed via transradial, transbrachial or transfemoral access. PCI through femoral artery was first successfully done in 1977 and only 12 years later in 1989, Campeau [2] first reported a series of 100 diagnostic CAGs by radial approach. Transradial approach is the current choice and default technique for both diagnostic & therapeutic invasive coronary procedures, with prognostic impact on patients’ morbidity and mortality, especially for those who are at hemorrhagic complications [4]
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