Transradial artery Palmaz-Schatz coronary stent implantation: Results of a single-center feasibility study

Abstract

The purpose of this study was to evaluate the feasibility and safety of implantation of unsheathed Palmaz-Schatz coronary stents introduced via the radial artery. Anticoagulation after coronary stenting carries the risk of vascular complications if large-bore guiding catheters are introduced via the femoral artery. These complications have serious local sequelae and lead to suboptimal anticoagulation and prolonged hospitalization. By combining 6F guiding catheters and low-profile dilatation catheters mounted with Palmaz-Schatz stents, smaller vessels such as the radial artery can be selected as the entry site. It is hypothesized that with this technique major puncture site—related complications rarely occur because hemostasis is easily achieved and because no veins and nerves are near this artery. With the double blood supply to the hand, radial artery occlusion is well tolerated. In 100 consecutive patients, stent implantation was attempted for 122 lesions in 104 vessels. Immediately after stent implantation and final angiography, the introducer sheath was withdrawn and intense anticoagulation and mobilization initiated. The radial artery puncture site was studied by two-dimensional and Doppler ultrasound. Successful stent implantation via the radial artery was achieved in 96 patients. In 2 patients, arterial puncture failed but was followed by successful stenting via another entry site. In 1 patient, stent implantation was achieved with a stent delivery system via the femoral artery after a failed attempt to cross the lesion with a bare stent via the radial approach, complicated by groin bleeding requiring transfusions and vascular surgery. One patient was referred for coronary bypass surgery because the stent could not reach a dissection in a tortuous left anterior descending coronary artery. Lesions were of type A ( n = 43 [35%]), B ( n = 30 [25%]), and C ( n = 49 [40%]). The reference diameter of the stented segments was 3.3 ± 0.5 mm (1.2 to 5.0 mm). Minimal luminal diameter increased from 1.1 ± 0.4 mm (0 to 2.1 mm) to 3.1 ± 0.5 mm (1.0 to 4.2 mm). Diameter stenosis was reduced from 67% ± 11% (37% to 100%) to 13% ± 10% (0% to 68%). Procedural success and an uncomplicated clinical course were achieved in 93 (93%) patients. One (1%) patient had subacute stent thrombosis, which was followed by successful percutaneous transluminal coronary angioplasty and coronary bypass surgery. Another patient died 2 days after stenting for unstable angina and poor left ventricular function, without signs of stent occlusion. In 1 patient radial artery bleeding developed and required surgical repair. None of the 4 patients with postprocedure radial artery occlusion showed signs of ischemia of the hand. Hospital stay was 5.2 ± 4.1 days. Patients ( n = 64) receiving coumadin at the time of admission were hospitalized for 4.1 ± 4.2 days; of this group, 22 (34%) patients were discharged <24 hours after stenting. It is concluded that transradial artery Palmaz-Schatz coronary stenting is feasible and safe. With intense anticoagulation early major entry site—related complications are rarely encountered.