Transradial artery coronary angioplasty

Abstract

This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site—related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery ( n = 5) or the brachial artery ( n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population. Minimal luminal diameter increased from 0.9 ± 0.3 (0 to 1.8) to 2.0 ± 0.5 (0.6 ± 3.6) mm, and diameter stenosis was reduced from 74% ± 11% to 24% ± 11%. In 3 patients a coronary stent was implanted via the radial artery because PTCA results were suboptimal. Of 98 patients with a successful PTCA, four (4%) had acute myocardial ischemia 1 to 24 hours after the procedure. In these patients an emergency second PTCA procedure via the femoral artery was performed successfully, but in 2 patients a myocardial infarction could not be prevented. No other major cardiac complications were encountered. No major entry site—related complications were seen, and no patient required vascular surgery or blood transfusions. In 10 patients radial artery pulsations were absent at discharge, and all 10 were asymptomatic. Of these 10 patients, late recanalization was evident in 5, and in 3 patients pulsations remained absent. PTCA via the radial artery is effective and safe and minimizes major puncture site—related complications.