Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure.

Lili Xu,Xiangfei Wang,Juying Qian,Meng Zhang,Chenguang Li,Hongbo Yang,Junbo Ge,Jiatian Cao,Yuxiang Dai,Zheyong Huang,Yanan Song,Kang Yao,Feng Zhang

doi:10.3389/fcvm.2022.730648

Abstract

BackgroundCurrent guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle-angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.MethodsPatients undergoing a transradial coronary procedure in our team from August 2015 to June 2020 were retrospectively investigated. We compared the demographic and interventional characteristics of 1,457 patients receiving advancement of unmodified guidewires (Traditional group) and 1,322 patients receiving advancement of the knuckle guidewire (Knuckle group). Afterwards we included 239 patients and randomized them according to a random number table to either the unmodified or the knuckle guidewire to further confirm the efficiency and safety of knuckle guidewire advancement.ResultsIn the retrospective analysis, unwilling passage of guidewire into branches occurred more in the Traditional group than in the Knuckle group (9.5 vs. 0.08%, p < 0.001). Two patients in the Traditional group experienced guidewire-associated perforation. One patient was treated with covered stent for internal mammarian artery perforation, while the other was managed with compression for brachial branch perforation. In the randomized controlled study, unwilling passage of guidewire also occurred more in the Traditional group (10.8 vs. 1%, p < 0.001). Median duration of guidewire advancement from the sheath to aortic root significantly decreased from 33 seconds in the Traditional group to 21 seconds in the Knuckle group.ConclusionActive knuckle angle guidewire represented a novel method to prevent unwilling passage and associated perforation with efficiency improvement and a reduction in radiation exposure.

Highlights

Radial artery access has been widely applied as a default route for diagnostic and interventional coronary procedures with reduced vascular complications, shorter hospital stay and improved outcomes compared to the femoral approach [1–5]
One patient was treated with covered stent for internal mammarian artery perforation, while the other was managed with compression for brachial branch perforation
We investigated a novel method, applying an active knuckle-angle 0.035-inch hydrophilic guidewire to prevent guidewire unwilling passage and related complications

Summary

Introduction

Radial artery access has been widely applied as a default route for diagnostic and interventional coronary procedures with reduced vascular complications, shorter hospital stay and improved outcomes compared to the femoral approach [1–5]. Some doctors prefer the J-tip guidewire which was originally designed for a large lumen in the transfemoral approach It has some limitations in transradial access, such as the potential risk of perforation before the guidewire enters a large vessel and the safe J tip forms. Another choice is an angle-tip 0.035-inch hydrophilic guidewire (Radifocus, Terumo, Japan) commonly used for its superiority in tortuosity and direction changes [8]. It can glide into small side branches without appreciable resistance, increasing the risk of subintimal dissection and perforation [9, 10]. This study sought to investigate the safety and efficiency of a novel method of active knuckle-angle 0.035-inch hydrophilic guidewire in transradial coronary angiography

Methods

Results

Discussion

Conclusion