Radial Angiography Research Articles

The effects of intra-arterial vasodilators on radial artery size and spasm: implications for contemporary use of trans-radial access for coronary angiography and percutaneous coronary intervention

Transradial access (TRA) offers advantages including decreased vascular complications, reduced length of hospital stay, and reduced cost. The size of the radial artery (RA) limits the equipment that can be used via TRA. Intra-arterial (IA) vasodilators prevent and treat RA spasm, yet are not uniformly used in TRA and their effect on the absolute size of the RA remains unknown. 121 patients undergoing TRA for cardiac catheterization were included. 78 patients underwent RA angiography prior to administration of IA vasodilators ('no vasodilator' group), 43 patients underwent radial angiography after administration of an IA verapamil and nitroglycerin cocktail ('vasodilator' group). Quantitative angiography was used to compare the RA diameters. Clinical characteristics were similar between the groups, except that patients in the 'no vasodilator' cohort were taller (1.67 ± 0.1 m vs. 1.73 ± 0.1 m, p=0.002), and heavier (84.9 ± 18.2 kg vs. 75 ± 17.1 kg, p=0.003). In the 'vasodilator' group the proximal RA diameter was larger (2.29 ± 0.47 mm vs. 2.09 ± 0.41 mm, p=0.02) as was the narrowest segment (1.83 ± 0.56 mm vs 1.39 ± 0.43, p<0.0001) compared to the 'no vasodilator' group. At the RA origin, 79.4% of those in the 'vasodilator' group were larger than a 6 Fr guide catheter, compared to 51.4% in the 'no vasodilator' group (p=0.004). At the narrowest segment a higher percentage of RAs in the 'vasodilator' group were larger than a 5 Fr guide catheter (65.1% vs 26.9%, p<0.001) and a 6 Fr catheter (34.9% vs 10.3%, p=0.001). IA vasodilators increase pre-procedural RA diameter in patients undergoing cardiac catheterization via TRA. This increase in diameter has important implications for procedural planning. Boyer et al. performed a blinded controlled clinical trial investigating the effects of intra-arterial vasodilators on radial artery size and spasm during cardiac catheterization. The study demonstrates that intra-arterial vasodilators significantly increased the radial artery size throughout the entire course of the vessel and significantly decreased the amount of radial artery spasm. The authors conclude that these findings support the use of intra-arterial vasodilators during cardiac catheterization and have important implications for emerging technologies such as larger bore sheathless radial procedures.

CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention

The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC). We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001). Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.

Characteristics of radial access site coronary procedures in patients with arteria lusoria among 5789 patients undergoing coronary angiography at a primary radial access centre

BackgroundAnatomical obstructions are the bane of radial access site for coronary procedures for inexperienced operators. The availability of better hardware in the performance of procedures by this route has mitigated...

Quiescent‐inflow single‐shot magnetic resonance angiography using a highly undersampled radial k‐space trajectory

We hypothesized that high undersampling factors could be used in conjunction with radial quiescent-inflow single-shot magnetic resonance angiography (MRA) to accelerate the data acquisition and enable multislice acquisitions. Seven subjects were imaged on a 1.5 T MRI system. For multislice quiescent-inflow single-shot MRA, the venous saturation radiofrequency pulse, in-plane saturation radiofrequency pulse, and quiescent interval were applied only once before the first slice. The mean (standard deviation) measurements for the intra-arterial signal-to-noise ratio were as follows: Cartesian 1 slice-29.3 (5.5); radial 1 slice, 92 views-22.3 (3.6); radial 1 slice, 46 views-18.5 (2.0); radial 2 slices, 46 views-18.3 (3.2); and radial 3 slices, 32 views-21.7 (3.9), normalized for pixel size to 15.8. Horizontal striping was present with multislice radial quiescent-inflow single-shot MRA (especially with the three-slice acquisition) due to variable T1 relaxation between the concurrently acquired slices, but the image quality remained diagnostic. Vascular pathology in patients with peripheral arterial disease was well shown by all techniques. Very high undersampling factors in excess of 18 have been demonstrated for nonenhanced MRA using a radial quiescent-inflow single-shot technique, enabling the acquisition of two to three slices per cardiac cycle. Scan time for a complete peripheral MRA could be shortened to 2 min or less.

Knots in the cath lab, an embarrassing complication of radial angiography

Most case reports or series describe knots in the venous system such as knots of Swan-Ganz catheters, pacing wires or thermodilution catheters. Knots during radial angiography are relatively rare. Here...

Management of an iatrogenic radial artery perforation: a case report

A 73-year-old female patient underwent transradial coronary angiography with stable angina and signs of significant myocardial ischemia revealed by exercise stress test. After insertion of a 6F radial sheath into the right radial artery and intra-arterial administration of heparin plus verapamil, the hydrophilic guidewire could not be advanced under fluoroscopic guidance. Immediately afterwards, radial angiography was performed, which displayed a radial artery perforation with significant contrast extravasation. The perforated segment was crossed meticulously with the same guidewire after additional vasodilator drug administration. Afterwards, a 5F TIG catheter was advanced to the axillary artery and held in place for 20 minutes with application of external compression with a sphygmomanometer cuff at the level of systolic blood pressure. The same maneuver was again performed following cuff deflation and completion of coronary angiography with the 5F catheter. Final angiography displayed complete sealing of the perforation without a need for neutralization of heparin. External compression was continued for two hours, and after documentation of normal triphasic radial artery flow by Doppler ultrasound (DUS), the radial sheath was removed. The patient was discharged the following day with no evidence of hand ischemia and well-palpable radial artery pulse. DUS demonstrated normal radial artery flow one month later. This unusual complication was managed successfully with a simple and easily applicable technique that can be performed in such cases.

Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape.

Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom's trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P < 0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.

Recanalization of a Chronic Radial Artery Occlusion Allowing Subsequent Complex Coronary Intervention

A 65-year-old man with previous coronary artery bypass grafting and recent recurrence of angina was referred for coronary angiography. His medical history included myelodysplasia with significant anemia (hemoglobin, 7.7 g/dL) and thrombocytopenia (platelets, 77×10 9 /L). A percutaneous coronary intervention was performed 4 years previous to an occluded native right coronary artery via the left radial artery. Given the increased risk of bleeding complications and a patent left internal mammary artery graft, coronary angiography was planned again via the left radial artery. The result of a modified Allen test was positive, demonstrating satisfactory ulnar arterial supply to the hand. Arterial puncture using a SURFLO micropuncture needle (Terumo Medical Corporation; Somerset, NJ) resulted in pulsatile blood flow back, but it proved impossible to advance the 0.021-inch introducer wire more than a few centimeters into the vessel. Therefore, the cannula on the introducer needle was advanced over the wire to secure arterial access and radial angiography was performed, which demonstrated radial artery occlusion (RAO; Figure 1; online-only Data Supplement Movie I). The occlusion was not believed to …

Radial Artery Anomalies and Subsequent Impact on Transradial Coronary Procedures—A Single Centre Experience

Background: Wollongong Hospital is a regional tertiary referral centre in NSW. A transradial approach for coronary angiography and intervention was commenced in March 2010. The transradial approach has a number of significant advantages over the femoral approach; however various technical challenges have impeded its utilisation. Some of these challenges relate to radial artery anatomy. Our aim is evaluate the incidence and influence of radial artery anomalies with regards to transradial procedures. Methods: Data related to baseline characteristics, procedure variables, radial artery anatomy and procedure outcome were collected on patients due to have retrograde radial arteriography performed between June 2011 and March 2012. Results: 135 patients were included in this study. Mean age was 67.05 years, M:F (75:60). In total 128 patients underwent retrograde arteriography (seven arteries unable to be viewed). The incidence of radial artery anomaly was 13/128 (10%). Anomalies identified were tortuous arteries (n = 5, 4%), loops (n = 4, 3%) and high bifurcations (n = 4, 3%). Overall success was 121/135 (89.6%). The success rate in patients with normal radial anatomy was 110/115 (95.6%) and in those with anomalies 11/13 (84.6%). The breakdown of success rate was 80% (4/5) in tortuous arteries and 75% (3/4) in both high bifurcations and loops. Of note the failure in the high bifurcation artery was due to spasm. Conclusion: Our study shows that radial artery anomalies are relatively common and the success rate of coronary procedures is also lower in these patients. The use of retrograde radial angiography can help operators evaluate radial artery anatomy and devise strategies to improve success rate.

TCT-521: Safety and efficacy of radial arterial injection of Nicorandil compared to the usual cocktail of nitroglycerine (NTG) and Diltiazem given during radial angiography

TCT-521: Safety and efficacy of radial arterial injection of Nicorandil compared to the usual cocktail of nitroglycerine (NTG) and Diltiazem given during radial angiography

We built the first public radial angiography laboratory contrary to the hesitation that conventional coronary angiography could have been performed in Erzincan

We built the first public radial angiography laboratory contrary to the hesitation that conventional coronary angiography could have been performed in Erzincan

Radial Angiography Experience in a Regional Centre

Radial Angiography Experience in a Regional Centre

Fast reduction of undersampling artifacts in radial MR angiography with 3D total variation on graphics hardware

Subsampling of radially encoded MRI acquisitions in combination with sparsity promoting methods opened a door to significantly increased imaging speed, which is crucial for many important clinical applications. In particular, it has been shown recently that total variation (TV) regularization efficiently reduces undersampling artifacts. The drawback of the method is the long reconstruction time which makes it impossible to use in daily clinical practice, especially if the TV optimization problem has to be solved repeatedly to select a proper regularization parameter. The goal of this work was to show that for the case of MR Angiography, TV filtering can be performed as a post-processing step, in contrast to the common approach of integrating TV penalties in the image reconstruction process. With this approach, it is possible to use TV algorithms with data fidelity terms in image space, which can be implemented very efficiently on graphic processing units (GPUs). The combination of a special radial sampling trajectory and a full 3D formulation of the TV minimization problem is crucial for the effectiveness of the artifact elimination process. The computation times of GPU-TV show that interactive elimination of undersampling artifacts is possible even for large volume data sets, in particular allowing the interactive determination of the regularization parameter. Results from phantom measurements and in vivo angiography data sets show that 3D TV, together with the proposed sampling trajectory, leads to pronounced improvements in image quality. However, while artifact removal was very efficient for angiography data sets in this work, it cannot be expected that the proposed method of TV post-processing will work for arbitrary types of scans.

Transradial Coronary Angiography and Intervention are Safe and may have a Short Learning Curve

Background: Trans-radial cardiac catheterisation is underutilised possibly because of perceived technical difficulty and increased radiation exposure. We sought to compare radial and femoral angiography and intervention procedural parameters as performed by experienced angiographers with varying radial access skills.

Management of iatrogenic radial artery perforation.

The aim of this study was to evaluate a new protocol allowing coronary angiography to be performed transradially in spite of the occurrence of iatrogenic radial artery perforation during catheterization. Nine patients with iatrogenic radial artery perforation were managed conservatively by inserting a long arterial sheath in the damaged radial artery up to the brachial artery, after which the diagnostic and/or interventional procedures that had motivated transradial catheterization were completed via the protected radial artery. Radial angiography performed immediately thereafter showed no extravasation, and no major vascular complications developed during follow-up. The day after the procedure, two patients had asymptomatic radial occlusion, but the other seven patients had normal radial pulses and reversed Allen test responses showing normal perfusion. A conservative management technique, installation of a long arterial sheath not only promotes resolution of iatrogenic radial artery perforation but also allows the procedures motivating catheterization to be completed transradially.

Radial loop and extreme vessel tortuosity in the transradial approach: advantage of hydrophilic-coated guidewires and catheters.

Between October 2000 and October 2001, all transradial cases performed by the author necessitating radial and upper arm angiography because of difficult advancement of standard guidewires or catheters were analyzed retrospectively. Fourteen of 594 (2.4%) transradial cases met the study criteria. Radial loops or stenosis and tortuosity in the subclavian or innominate artery were responsible for the difficult access. Several examples of patients with access problems are presented. A technique using a hydrophilic-coated guidewire and a new hydrophilic-coated guiding catheter is described.

Feasibility and Problems in Transradial Coronary Angiography and Intervention

Background and Objectives:The transradial coronary angiography and intervention is on the increase with its satisfactory results. It gives advantages of reduced vascular complication and increased comfort of patients. We evaluated the feasibility and problems of transradial coronary angiography and intervention as a routine procedure. Materials and Method:Between February 1998 and December 1999 transradial approach was attempted in 750 patients with normal Allen test. Radial angiography was performed to assess the radial artery spasm and tortuosity. Arterial sheath was removed immediately after the procedure and vascular complications were evaluated before discharge. Results:Radial artery puncture was successful in 738 (98%) patients. Transradial coronary angiography was successful in 719 (96%) patients. We failed in coronary angiography in 19 patients and the main reasons were tortuous subclavian artery in 11 patients and radial artery spasm in 5 patients. Transradial coronary angioplasty was performed successfully in 185 (95%) of 194 patients. In 9 patients intervention was switched to transfemoral approach because of tortuous subclavian artery. Complications were severe radial artery spasm in 13 (1.8%), minor subcutaneous hemorrhage in 7 (0.9%), non-ischemic radial artery occlusion in 4 (0.5%) and radial artery perforation in 1 (0.1%). But, there were no major complications requiring vascular surgery or transfusion. Conclusion:Transradial coronary angiography and intervention might be useful and safe as a routine procedure. The major limitations in transradial approach were radial artery spasm and toruosity of brachial or subclavian artery. (Korean Circulation J 2000;30(9):1083-1091)