Mechanical Circulatory Support in Transradial or Transbrachial Intervention for Acute Coronary Syndrome

Hon-Kan Yip,Cheuk-Man Yu

doi:10.1007/978-94-017-7350-8_25

Hon-Kan Yip, Cheuk-Man Yu

https://doi.org/10.1007/978-94-017-7350-8_25

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Although transfemoral arterial approach (TFA) was the first developed method for coronary angiography and percutaneous coronary intervention (PCI), it has its own disadvantages, including the need for the bed rest for the requirement of puncture site compression after the procedure, vascular complications of local hematoma, psoas hematoma, arterio-venous fistula and pseudoaneurysm, as well as difficult access due to tortuous aorta or occlusion of femoral-iliac-aortic route [1–7]. Thus, to develop an alternative modality with easily approach, lesser vascular complications and comparable safety as the femoral arterial approach for PCI is of utmost importance. Transradial arterial approach (TRA) for coronary angiography and PCI is therefore developed as an alternative and even well-accepted first line approach. In fact, TRA which is a reasonably simple route of vascular access [8–10] for catheter-based coronary intervention, and has been developed for almost 20 years. As the safety and efficacy of this method has already been extensively discussed and validated for a long time by many clinical studies worldwide [8, 10], TRA is currently one of the most popular approaches, especially in Asia, for elective PCI [10–15]. Additionally, clinical studies have further proved that TRA is safe and efficacious in elective coronary angiographic study on an out-patient basis [15], elective left main coronary intervention [16], cerebral angiographic study, and vertebral or carotid stenting [17, 18]. Furthermore, while TRA for primary PCI is already a daily practice for hemodynamic stable patients in many medical centers of the world, in particular in Asia [19, 20], how to utilize the TRA for coronary intervention for acute ST-segment elevation myocardial Infarction (STEMI), non-STEMI and unstable angina with hemodynamic instability with the requirement of circulatory/mechanical support is an important issue that should be realized in our clinical practice.

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