Radial Access Site Research Articles

Abstract 4118076: Right Innominate Artery Endovascular Intervention Via Single Radial Access and Use Of Embolic Protection

Introduction: The occurrence of innominate artery stenosis is less prevalent compared to subclavian artery disease. Small studies suggest up to 8% of individuals initially diagnosed with suspected subclavian steal syndrome may present with innominate artery lesions. Deployment of an embolic protection filter within the internal carotid artery during percutaneous intervention of the innominate artery presents a solution to mitigate embolism. Case: A 70-year-old female with a history of peripheral vascular disease presented with claudication in both arms, manifested as pain in both arms. Her left subclavian was stented months prior to presentation. An aortogram revealed severe stenosis of the innominate artery (Figure 1). Since multiple attempts to cross the lesion antegrade from the femoral access site were unsuccessful, we proceeded with the successful deployment of an embolic protection filter in the right internal carotid artery via our right radial artery access site (Figure 2). Using the right radial artery, we passed a long run-through guidewire into the distal abdominal aorta. Due to severe aortic tortuosity, we were unable to snare the wire from the aorta. Therefore, we upsized the radial sheath to 7 French over both wires (runthrough and bare). Using a support catheter, we exchanged the runthrough wire for a Glidewire Advantage. We advanced an 8 x 29mm balloon expandable stent to the area of innominate stenosis and deployed it (Figure 3). We postdilated the stent with a 14mm balloon. Angiography demonstrated adequate expansion. On follow up, the patient was without claudication and had triphasic flow in the innominate and left subclavian arteries. Discussion: Treating innominate artery stenosis via radial access employing a sole entry point for both embolic protection and treatment administration offers a substitute where additional access is infeasible. Modern embolic protection techniques are superior due to their flexibility and ease of use. In this case, placing the embolic protection device in the carotid artery was mandatory through the sole radial access to prevent trapping the filter behind the innominate artery stent. We were able to perform both the embolic device placement and the stenting with the same radial access. Conclusion: Endovascular intervention of innominate artery stenosis via radial access, utilizing a single radial access for both embolic protection and treatment delivery, presents an alternative when femoral access is not feasible.

Procedural Outcomes With Femoral, Radial, Distal Radial, and Ulnar Access for Coronary Angiography: A Network Meta-Analysis.

Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]). Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365.

Radial Artery Access for Peripheral Vascular Interventions: A Review of the Literature

ObjectivePercutaneous radial artery access for lower extremity arterial interventions has increased in popularity in recent years. The purpose of this review is to summarize available data regarding its safety and efficacy. MethodsStudies related to the use of the percutaneous radial artery access for peripheral artery intervention were identified in a search of the PubMed database. Outcomes evaluated were access complications and technical success. ResultsThirteen studies that evaluated patients undergoing percutaneous radial artery access with peripheral interventions were reviewed. Several studies were able to demonstrate use of up to 8Fr sheath; however, the majority was 6Fr. Reported rates of asymptomatic radial artery occlusion ranged up to 16% and reported radial artery access site complication rate ranged from 0-15.6%. Technical success ranged from 74%-98.7%. ConclusionsPercutaneous radial artery access can effectively and safely be used in select patients.

Efficacy and Safety of Axiostat® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers.

Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4-8 Fr introducer sheath.

Transradial Access Failures During Neuroangiography for Patients With Moyamoya.

Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.

Abstract No. 36 Radial Access in the Setting of Angiography and Embolization for Trauma: Our Experience

Traditionally, transradial artery access (TRA) has been secondary to transfemoral artery access (TFA) for interventional radiology (IR) procedures, especially in the setting of trauma. As interventionists have demonstrated increasing confidence in TRA in emergent settings such as in cardiac and stroke cases, the use of TRA in the setting of trauma has gained increasing traction. We aim to describe our experience with TRA for IR angiography and embolization in the setting of trauma. We performed a retrospective review of all arterial angiography and possible embolization cases in the setting of trauma performed by IRs at our level 1 trauma center from 2015 to 2022. Cases were extracted from our institutional database using the search terms “trauma,” “gunshot,” “gsw,” and “mvc.” We manually reviewed and excluded the non-trauma cases. 630 trauma patients (mean age, 41 years; 30.4% female) underwent 685 arterial angiography with possible embolization. 91.7% (628/685) of cases underwent TFA; 6.9% (47/685) underwent TRA; 0.1% (1/685) underwent brachial artery access; 0.1% (1/685) underwent subclavian artery access; and 0.4% (3/685) underwent TFA first but transitioned to TRA. There was no significant difference in age (mean, 40.9 TFA; mean, 39.1 TRA; P = 0.42) or sex (P = 0.87) between those who underwent TFA vs TRA. TRA were successfully performed for 23 pelvic, 1 splenic, 2 renal, 10 hepatic, 1 mesenteric, 2 intercostal artery, and 8 combination cases. Reasons for TFA to TRA transition include difficulty accessing the femoral artery or the bleeding target artery. Reasons given for attempting TRA before TFA include groin hematomas and pelvic binder. 87.2% (41/47) had a pre-procedural CT/CTA demonstrating hemorrhage or pseudoaneurysm. 72.3% (34/47) had a post-procedure CT/CTA for follow-up. The average contrast usage for TRA cases was 106.4 cc with mean fluoro time of 17.5 min. The reintervention rate was 14.9% (7/47) due to rebleeding or no active bleeding seen on the initial angiogram. There were no reported radial access site complications. Although IRs traditionally have relied on TFA for trauma angiography and embolization, TRA can be an alternative, safe option for a variety of emergent cases. TRA may be the route of choice in trauma patients with groin hematomas or pelvic binders.

Abstract 11582: Implications of Glycoprotein 2b/3a Receptor Antagonist Use During Percutaneous Coronary Intervention

Introduction: Glycoprotein 2b/3a receptor antagonists (Gp 2b/3a) were once widely used during PCI. However, due to concerns for excess bleeding, the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization downgraded their use during PCI to Class IIa. Hypothesis Higher rates of Gp 2b/3a use will be associated with higher bleeding rates, particularly in hospitals that use more femoral arterial access. Methods: We investigated the prevalence of Gp 2b/3a use during PCI among 18 PCI centers in a regional cardiac quality collaborative, between January 2017 and June 2021. Since radial access has lower bleeding rates than femoral access, we determined the impact of Gp 2b/3a use on total bleeding as defined by NCDR, stratified by access site. Results: During the study period 36,975 PCI were performed. The rate of Gp 2b/3a use among PCI centers ranged from 2.6% to 59.3% (mean ± SD 20.5% ± 18.5%). PCI centers were analyzed according to whether Gp 2b/3a use was above or below the mean frequency, and according to arterial access site preference (femoral &gt; 45% or radial &gt; 55%). Among low Gp 2b/3a use centers, centers that also favored radial access had lower bleeding rates than high femoral access centers (1.84% vs 2.43%, p=0.009). However, the bleeding risk benefit of radial access was lost in the high Gp 2b/3a usage hospitals, with bleeding rates of 4.54% in the high radial centers versus 3.41% in the high femoral centers (p&lt;0.001) (Table). Among high radial access site centers, the rate of bleeding was 2.5-fold greater in high versus low Gp 2b/3a use centers (p&lt;0.001). Conclusions: There is a wide range of Gp 2b/3a use during PCI. Above average Gp 2b/3a use increased total bleeding and neutralized the bleeding risk benefit of radial access. Further study is required to determine why bleeding rates in high radial centers were greater than high femoral centers, when Gp 2b/3a use was above average. Adherence to current guidelines for Gp 2b/3a use may reduce bleeding risk during PCI.

The effect of right conventional radial artery access site and left distal radial artery access site on quality of life in coronary angiography: Which route is more appropriate?

Objectives: There are not many studies comparing the right conventional and left distal radial (anatomical snuffbox) access in coronary angiography (CAG) or percutaneous coronary intervention (PCI) in terms of patient satisfaction and complications; therefore, in this study, we planned to compare these two approaches and determine the ideal radial access site for the patients. Patients and methods: A total of 120 patients (80 males, 40 females; mean age: 59.2±11.7 years; range, 18 to 90 years) who underwent CAG or PCI via the radial artery between February 2022 and April 2022 were included in the prospective observational study. The patients were divided into right conventional radial artery access (Group 1; n=68) and left distal radial artery (access (Group 2; n=52) groups. Results: The rate of minor bleeding was higher in the right conventional access group compared to the left distal access group (16.2% vs. 3.8%; p=0.031). Major bleeding, hand ischemia, and radial artery occlusion were not observed in the study population. The rate of patients who had pain that disrupts daily activities was statistically higher in Group 1 than in Group 2 (17.6% vs. 5.8%). The patients in Group 2 were more satisfied with the transradial CAG/PCI compared to Group 1 (94.3% vs. 66.2%; p=0.001). Conclusion: Left distal radial artery access from the anatomic snuffbox was a safer method than right conventional radial artery access for CAG or PCI. Patients were more satisfied with the left distal radial access than the right conventional radial access.

Transradial Versus Transfemoral Approach for Endovascular Thrombectomy of Left Anterior Circulation Stroke With Bovine Arch

Transradial Versus Transfemoral Approach for Endovascular Thrombectomy of Left Anterior Circulation Stroke With Bovine Arch

Robotic Percutaneous Coronary Intervention During COVID-19 Pandemic: Outcomes and Cost Effectiveness With Procedural Distancing.

The COVID-19 pandemic raised many questions, including the need to maintain distancing and the importance of full personal protection equipment (PPE) for healthcare workers. Robotic-assisted percutaneous coronary intervention (R-PCI) can be advantageous during a pandemic to facilitate procedural distancing for cath lab personnel and to decrease the cumulative amount of PPE employed. All patients who underwent R-PCI during the early phase of the pandemic were evaluated at a single institution. Procedural characteristics, complexity of disease, and use of adjunctive imaging or physiology were queried. Mean R-PCI time, procedure and fluoroscopy times, radiation dose, and contrast volume were collected. Cost of PPE incurred with R-PCI was evaluated in comparison with traditional cases. Furthermore, procedural distancing from patients for operators was objectively quantified to compare with traditional cath lab cases. Thirteen patients were treated using R-PCI. Radial access site was utilized in 54% and the left circumflex artery was treated most frequently (in 50% of cases). The complexity of cases performed was illustrated by revascularization of chronic total occlusions in 2 patients (14%) as well as adjunctive intravascular ultrasound or instantaneous wave-free ratio in 4 patients (29%). Mean R-PCI time was 45.38 minutes, manual time was 25.66 minutes, and total procedure time was 71.08 minutes. Average fluoroscopy time was 18.27 minutes, contrast volume was 143.85 mL, and radiation dose was 747.15 mGy. R-PCI was more cost effective, with total average PPE cost of $330.71 in comparison with $496.08 for traditional PCI (absolute difference, $165.36). Furthermore, R-PCI demonstrated substantial procedural distancing of operators from patients (8.14 feet for R-PCI vs 2.75 feet for traditional PCI; absolute difference, 5.39 feet). R-PCI could be a promising strategy during a pandemic by facilitating procedural distancing, minimizing staffing exposure risk, and decreasing PPE cost.

Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience.

Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.

Manual extraction of a dislodged and migrated DES from radial artery puncture site

Abstract This is a rare case of manual retrieval of a dislodged stent from radial artery access site under local anaesthetic. The LAD PCI was complicated by stent distortion which occurred due to in adequate preparation of a calcified, tortuous lesion. The dislodged stent was unable to be retrieved percutaneously and had to be left in the distal radial artery which a few weeks later migrated from the radial artery and taken out manually from the puncture site.

An Inexpensive Cardiovascular Flow Simulator for Cardiac Catheterization Procedure Using a Pulmonary Artery Catheter.

Cardiac catheterization associated with central vein cannulation can involve potential thrombotic and infectious complications due to multiple cannulation trials or improper placement. To minimize the risks, medical simulators are used for training. Simulators are also employed to test medical devices such as catheters before performing animal tests because they are more cost-effective and still reveal necessary improvements. However, commercial simulators are expensive, simplified for their purpose, and provide limited access sites. Inexpensive and anatomical cardiovascular simulators with central venous access for cannulation are sparse. Here, we developed an anatomically and physiologically accurate cardiovascular flow simulator to help train medical professionals and test medical devices. Our simulator includes an anatomical right atrium/ventricle, femoral and radial access sites, and considers the variability of arm position. It simulates physiological pulsatile blood flow with a setting for constant flow from 3 to 6 L/min and mimics physiological temperature (37°C). We demonstrated simulation by inserting a catheter into the system at radial/femoral access sites, passing it through the vasculature, and advancing it into the heart. We expect that our simulator can be used as an educational tool for cardiac catheterization as well as a testing tool that will allow for design iteration before moving to animal trials.

Sex differences in transradial access site characteristics and crossover in STEMI

Abstract Objective To assess the differences according to sex in radial artery access site characteristics and crossover and it's influence on the success of ST segment elevation myocardial infarction (STEMI) procedures with primary chosen transradial access site in a large series of patients. Background Transradial angiography (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the radial artery. Methods All 5092 consecutive STEMI patients from our center, in the period from March 2011 until December 2017 were examined. Patient were divided in two groups according to sex. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, transfer to other access sites, transfer direction and procedure time were analyzed. Access site bleeding complications and in-hospital mortality were also recorded. Primary end-point of the study was the occurrence of TRA failure and need to crossover to another access site to finish the procedure. Results From the STEMI population in this period the female group had 1326 PPCI treated patients and the male group 3766 patients. The female group of patients was older 65±11 than the male group 59±11 (p&amp;lt;0,0001). BMI was 27 vs. 30 in the male group (p=0.0003). Most common risk factors in both groups were hypertension, smoking and diabetes, with the latter being more frequent in the female group p&amp;lt;0,0001. Radial artery anomalies were more frequent in the female group 8,8% vs 6,5% (p&amp;lt;0,0001), with complex RA loop and tortuous RA having double percentage than in their male counterparts. Primary chosen TRA access site failure occurred in 4.6% (61) vs. 3.5% (97) of STEMI patients (p&amp;lt;0.0001). Most common access site crossover site was right ulnar access in both groups with 57 and 61% accordingly. Access site bleeding complications, were more common in the female group with 4.4% vs. 3.2%, also this difference persisted in EASY score hematoma 3 to 5. Clinical radial artery spasm was significantly more frequent in female patients 5,7% vs. 2.2% (p&amp;lt;0.0001). In-hospital mortality rate was similar in the two group of patients. Conclusion Female sex is a significant risk factor for TRA failure in STEMI usually connected to smaller size of RA and the more common finding of radial artery anomalies and spasm. Funding Acknowledgement Type of funding sources: None.

Transradial Access for Non-Coronary Intervention: Initial Experience of Ramathibodi Hospital

Objective: To describe initial experience of transradial access (TRA) for non-coronary intervention performed at body interventional radiology unit. Materials and Methods: A retrospective descriptive study was performed and included 31 cases from 27 patients that underwent TRA in the present study’s unit between May 2018 and January 2019. All cases were pre-operatively evaluated for radial artery size by ultrasound (US) and verified palmar arch patency using Barbeau test. To proceed to TRA, the radial artery diameter must be at least 1.8 mm and the Barbeau test must not be classified in type D. The primary endpoint was success rate. Secondary endpoints were patency of radial artery and other access site complication after TRA. Results: The technical success rate was 100% without crossover to transfemoral access (TFA). Asymptomatic radial artery occlusion (RAO) was observed in four cases (12.9%) using US at 24-hour after the procedure. According to statistical analysis, none of the present studied parameters showed statistically significant association with the RAO. The other access site complication detected was pseudoaneurysm, which was found in two cases. Conclusion: TRA is a promising alternative access for non-coronary intervention. Vascular access site complications are rarely clinically significant but nevertheless still a concern. Keywords: Transradial access; Non-coronary intervention; Complication; Radial artery; Patency

Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes

BackgroundLittle is known about rates of access site (transradial (TRI) or transfemoral (TFI)) preference for percutaneous coronary intervention (PCI) and in-hospital costs of patients undergoing these procedures in lower-and middle-countries. Here, we report on access site use, in-hospital costs and outcomes of patients undergoing PCI in Vietnam. MethodsInformation from 868 patients were included in the cohort of 1022 patients recruited into the first PCI registry in Vietnam. The total hospital costs and in-hospital outcomes of patients undergoing TRI and TFI were compared. Hospital costs were obtained from the hospital admission system, and major adverse cardiac events, major bleeding events and length of stay were identified through review of medical records. FindingsTRI was the dominant access site for interventionists (694/868 patients). The TFI group reported more lesions of the left main artery, more previous coronary artery bypass grafts and previous PCI in comparison with the TRI group (all p < 0.05). The TRI group was associated with a lower overall cost of admission (the adjusted difference was -1526.3 USD, 95% confident interval CI (-1996.2; -1056.3), shorter length of hospital stay (-2 days, CI (-2.8; -1.2)) and lower rates of major bleeding post-procedure. Procedural factors such as radial access site, left main disease, PCI ≥2 stents, and PCI ≥ 2 lesions having the most impact on the in-hospital cost of patients undergoing PCI. InterpretationsAmong patients undergoing PCI, TRI was associated with lower costs and favourable clinical outcomes relative to TFI FundingThis research received partial financial support from Curtin University, Australia.

Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized trials.

It is still debated if benefits associated with radial versus femoral access for coronary angiography and percutaneous coronary interventions (PCI) are due to the access site selection itself, operator expertise or other underlying mechanisms. We searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access site for coronary angiography and PCI. Primary safety endpoint was major bleeding. Coprimary efficacy endpoints were stroke and myocardial infarction (MI). This study is registered with PROSPERO. We identified 31 trials (30,096 patients, PCI performed in 21,225 patients). Radial compared to femoral access was associated with a significant risk reduction in major bleeding (OR 0.53, 95%CI 0.42-0.66, I2 = 3.3%). Findings were consistent regardless of clinical characteristics or whether coronary angiography was performed with or without PCI. The benefit of radial access was significantly increased in studies published before 2010 and in patients with chronic coronary syndrome. Risk for stroke (OR 1.11, 95%CI 0.76-1.64, I2 = 0%) and MI (OR 0.90, 95%CI 0.79-1.04, I2 = 0%) were comparable between the groups. Risk for mortality and vascular complications were significantly lower with radial than femoral access. In patients undergoing coronary angiography and PCI, radial access is associated with a significant risk reduction in bleeding, vascular complications, and mortality compared to femoral access. The risk of stroke or MI were comparable in patients with radial or femoral access.

Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility.

In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of <2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n = 213], intracranial intervention [n = 64], head and neck intervention [n = 30], and stroke intervention [n = 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n = 5), radial artery occlusion (n = 1), and acute severe radial artery spasm (n = 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n = 1). Twenty-six cases (7.9%) required crossover to transfemoral access. The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.

Ultrasound guidance versus direct palpation for radial artery cannulation in adults undergoing cardiac surgery post transradial catheterization

Background: Arterial cannulation is a frequent and essential procedure for continuous blood pressure monitoring and arterial blood sampling. The radial artery is the most commonly used for arterial cannulation. Radial access for coronary angiogram & intervention is increasingly used worldwide. Patients undergoing repeated transradial cannulation in same arm, the rate of radial access site failure increased with successive procedure. Traditional placement of radial artery cannulation is performed by using anatomical knowledge and pulse palpation as a guide. Ultrasound can facilitate access to artery and is useful in patients with low perfusion, arrhythmias, obesity and previously unsuccessful attempts with palpation technique. Attempt is made to evaluate the better procedure among traditional direct palpation Radial artery cannulation and USG guided cannulation in this study.Methodology: A total of 86 patients undergoing cardiac surgery post transradial catheterization were selected and randomized into ultrasound group and palpation group. It is a prospective, randomized, interventional study. Both the techniques were compared in terms of Total number of attempts, Time taken to cannulate, Complication related to procedure, Failure rate, Number of cannula used. Statistical analysis was performed by the software SPSS 22.0 version. Normality was checked by Shapiro Wilk test. To find the significant difference in means of two groups we used independent t-test and to find the association between categorical variables we used chi-square test or Fishers Exact test. p value <0.05 was considered as statistically significant.Results: Out of the 86 patients, the initial randomized method was successful in 81 patients (42/43 in USG and 39/43 in DPG group). USG group had a mean cannulation time of 57.1 seconds while in DPG group mean time was 81.51 seconds with a standard deviation of 24.923 and 50.83 respectively with p value was 0.009. The mean number of attempts in USG group is 1.24 with standard deviation of.484, in DPG group mean was 1.59 and standard deviation was 0.91 with a p value of 0.036 which is statistically significant. Even though, number of cannulas used in ultrasound group was fewer compared to palpation group, it was not statistically significant. Ultrasound showed less failure rate but statistically not significant with p value of 0.167.Conclusion: The use of ultrasound for radial artery cannulation in post transradial artery catheterized patients helps in faster insertion of cannula, requires less attempt for cannulation compared to traditional palpatory method. The complications were very low for both the methods, so ultrasound did not offer any advantage regarding reduction of complications following arterial cannulation.

Applicability of left distal radial artery access site in ST-segment elevation myocardial infarction; A comparative evaluation with the conventional transfemoral approach.

Left distal radial artery (LDRA) has got high popularity as an alternative safe access site in coronary angiography. However, little is known about its applicability in primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients. We aimed to assess the convenience of LDRA access in STEMI patients and make the comparative evaluation with the transfemoral (TF) route. A total of 91 consecutive STEMI patients who underwent PPCI from January to June 2019, were analyzed. Experienced operators, unaware of the study were left free of access site decision. Comparative demographic features and clinical outcomes were recorded during hospitalization. LDRA was used in 30 patients, whereas 61 patients underwent a TF approach. Successful PPCI was achieved in high rates in both groups (LDR: 90% vs TF: 91.8%: p = 0.795). On admission, KILLIP (II, III) class was higher in the LDRA group (23.3% vs 3.4%), whereas stent thrombosis, arhythmias were higher in the TF group (0% vs 6.6% p = 0.151; 6.7% vs 18% p = 0.355 respectively). Puncture time was relatively similar between groups (28.63 vs 28.93 s p = 0.767). Fluoroscopy time, total radiation exposure and hospital duration was found lower in the LDRA group (10.11 vs 13.75 min p < 0.001; 917.87 vs 1940.91 mGy p < 0.001; 4.2 vs 6.2 days p = 0.024 respectively). In-hospital mortality was found higher in the TF group (0% vs 18% p = 0.013). In the acute management of STEMI, LDRA access site can be a convenient alternative to TF approach with shorter hospital duration and complication rates.