Transulnar artery approach in STEMI - Best alternative to radial?

Abstract

Abstract Background Transulnar artery approach is a valuable alternative wrist access site for percutaneous coronary interventions. Currently published data about using transulnar approach (TUA) in the STEMI setting are missing. Due to its similarities with transradial approach (TRA), TUA in STEMI (ST segment elevation myocardial infarction) procedures can help in decreasing access site bleeding and vascular complications without sacrificing procedural success. Purpose To assess the success and safety of Transulnar access in STEMI. Materials and Methods In the period from March 2011 until December 2021, 8013 consecutive STEMI patients underwent primary PCI (percutaneous coronary intervention) in our center. All consecutive patients with transulnar approach (TUA) were included in a single center prospective registry of effectiveness and safety. The primary outcome was procedural success through ulnar access. We also examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TUA. Results In this period, 172 STEMI patients (2.1%) underwent PPCI through transulnar approach. Mean age of patients was 60 ± 12 years with 27% females. All procedures were successfully performed through right TUA. There were no STEMI TUA cases with crossover to Transfemoral approach. In 150 patients (87%) TUA was the primary choice of puncture due to no palpable radial artery from previous radial artery occlusion. In 22 patients (12.7%) the reason for crossover from primary TRA to TUA were complex RA anomalies. Type 3 and 4 EASY Score hematoma was present in 4 patients (2.3%). 7% of patients had over 1 access site puncture. UA spasm was registered in 1.7%. Mean procedural time was 32±23 min and fluoroscopy time was 8.5±9.2 min. Ulnar artery anomalies were registered in 1% of patients. There were no ulnar artery occlusions detected at discharge. There were no clinical or ischemic hand complications seen during clinical follow up. Conclusion Transulnar approach is safe and feasible alternative wrist access in the STEMI setting and can further decrease TFA crossover.