Abstract
BackgroundFor coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach. But the endomyocardial biopsy (EMB) approach is usually done by a transfemoral or cervical access known to be associated with an increased risk of artery puncture and its potential complications (i.e., false aneurysm, artery-venous fistula) and needs post-procedural immobilization. A transradial approach for EMBs is not standardized. The aim of our study is to validate safety and efficacy of the transradial access approach for left ventricular EMB, and to define patients eligible for a safe and successful procedure.Methods and ResultsWe evaluated the transradial access using a 7.5 F sheathless multipurpose guiding catheter to obtain EMBs from the left ventricle (LV). 18 patients were included. The transradial success rate was 100% (18/18). There were no periprocedural cardiac complications. Immediate post-procedural ambulation could be achieved in all patients. Although radial artery pulse was confirmed by ultrasonic vascular Doppler after removal of the guide in 100% (18/18) of the patients, 50% (9/18) of the patients showed occlusion of the radial artery RAO) by duplex sonography proximal to the access site. 33% (3/9) of the patients in the RAO group and 11,1% (1/9) of the patients in the patent radial artery (RAP) group, respectively, experienced mild pain after the procedure in the right lower arm. Colour Doppler ultrasonography of the right radial artery performed 24 h after the procedure revealed radial occlusion in 50% (9/18) of the patients. The diameter of the radial artery was significantly smaller in the RAO group (p = 0,034), peak systolic velocity (PSV) of the right ulnar artery was significantly higher in the RAO group (p = 0.012). Peak systolic velocity of the opposite radial artery was significantly lower in the RAO group (p = 0,045). Gender, sex, diabetes, radial artery inner diameter ≤2.5 mm and lower peak systolic velocity of < 50 cm/s are predictors of RAO.ConclusionThe present study demonstrates the safety and efficacy of a transradial access for EMB using a highly hydrophilic sheathless guiding catheter.
Highlights
For coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach
The 2007 American Heart Association/American College of Cardiology Foundation/European Society of Cardiology scientific statement on endomyocardial biopsy (EMB) limited its class I recommendations to unexplained new-onset heart failure of less than 2 weeks duration associated with hemodynamic compromise or unexplained new onset heart failure of 2 weeks to 3 months duration associated with a dilated left ventricle and new ventricular arrhythmias or conduction disturbances [3]
Patient population Mean age in both groups was similar (44.9 years in the occluded radial artery group (RAO) versus 47 years in the patent radial artery group (RAP)), whereas there were twice as many female patients in the occluded radial artery group (RAO 44% versus RAP 22% gibt es hierzu einen p-Wert? Das muss doch statistisch signifikant sein.). Both groups had increased mean BMI (BMI in the radial artery occlusion (RAO) group was 27 kg/m2 versus 25 kg/m2 in the RAP group). Both groups displayed severely impaired LVEF function, whereas the left ventricular end-diastolic diameter was significantly larger in the RAP group (LVEDD in the RAO group 52 mm versus 63 mm in the RAP group, P < 0,05))
Summary
For coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach. In a recent position statement from the ESC [1], the recommendation for EMB was extended, including patients with a pseudo-infarct presentation after excluding coronary artery disease, myocarditis and inflammatory cardiomyopathies, as well as for patients with rapidly advancing cardiomyopathy refractory to conventional therapy. This change responds to the more widespread availability of immunohistochemical and viral genome detection techniques, which improve the ability to detect the underlying cause of myocarditis. An increasing number of patients can benefit from specific treatment
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