Radial Artery Access Research Articles

ARCANGELO: an observational, prospective study with acute coronary syndrome patients undergoing percutaneous coronary intervention who receive cangrelor transitioning to oral P2Y12 inhibitors

Abstract Background The use of oral platelet P2Y12 receptor inhibitors, to reduce the risk of thrombotic complications related to Percutaneous Coronary Intervention (PCI), have some limitations in the acute phase, e.g., the delayed onset of action and lack of bioavailability in critical patients. Cangrelor is the only intravenous P2Y12 inhibitor, which based on its quick onset and offset of action is a valid alternative option for antiplatelet therapy, particularly for patients who are unable to take oral medications or for whom oral administration is not adequate. Notably, during the clinical development program of cangrelor, ticagrelor and prasugrel were not marketed and, therefore, the pivotal studies were conducted only with transitioning to clopidogrel. The aim of ARCANGELO study was the evaluation of the safety and effectiveness of cangrelor when administered to patients with Acute Coronary Syndrome (ACS) undergoing PCI in a real-world setting, including patients who received cangrelor transitioning to either clopidogrel, prasugrel, or ticagrelor. Methods Adult patients eligible to PCI for ACS who received cangrelor and who consented to take part in the study in 28 Italian centers, were followed in the 30 days after PCI. Bleedings, major adverse cardiac events (MACEs), and adverse events were recorded. The primary outcome was the incidence of any bleedings, according to BARC (Bleeding Academic Research Consortium) criteria, at 30 days post-PCI. Results A total of 1,004 patients were enrolled and 995 (99.2%) patients were eligible for analysis. Median (IQR) age was 65 (56-73) years, and 771 (77.5%) patients were males. 597 (59.9%) patients had ST-segment Elevation Myocardial Infarction; 509 (51.2%) patients had multi-vessel vessel coronary artery disease. A radial artery access was used in 926 (93.1%) patients and drug-eluting stents were implanted in almost all patients (n=972, 97.7%). All 995 patients included in the analysis received 30 micrograms/kg by intravenous bolus and 4 micrograms/kg/min by intravenous infusion. 730 patients (73.4%) were then transitioned to ticagrelor, 127 (12.8%) to prasugrel, and 138 (13.9%) to clopidogrel. 52 (5.2%) (95% CI 3.9% - 6.8%) patients experienced at least one bleeding event up to 30 days post-PCI. Five patients (0.5%) experienced at least one BARC type 3-5 (moderate-severe) bleeding (all type 3). Fourteen (1.4%) patients presented with at least one MACEs during observation (6 [0.6%] death, 7 [0.7%] myocardial infarction, 2 [0.2%] stent thrombosis). Six (0.6%) patients experienced at least one Treatment-Emergent Adverse Events related to cangrelor. Conclusions The results of this large real-world evidence study confirm that the use of cangrelor in patients with ACS undergoing PCI and transition strategy to the currently used P2Y12 oral inhibitors is safe and effective in daily practice.

Transradial or Transulnar Long Sheath Access to the Brachial Artery Allows for Neuroendovascular Procedures in Patients with Radial or Ulnar Artery Occlusion

Transradial access is an important tool for many neuroendovascular procedures. Occlusion of the radial or ulnar artery is not uncommon after transradial or transulnar access and can present a challenge for patients requiring repeat angiography. Between March 2022 and June 2023, patients undergoing transradial or transulnar angiography who were found to have a radial artery occlusion or ulnar artery occlusion were identified. Repeat catheterization of the occluded artery was attempted using a 21-gauge single wall puncture needle and a 0.021-inch wire to traverse the occlusion and insert a 23-cm sheath into the brachial artery. A total of 25 patients undergoing 26 angiograms during the study period were found to have a radial artery occlusion or ulnar artery occlusion. Successful repeat catheterization of the occluded artery was achieved in 21 of 26 cases (80.7%). Outer diameter sheath size ranged from 5 Fr (0.0655 inch) to 8 Fr (0.1048 inch). No access complications were encountered. Number of prior angiograms, time since prior angiogram, and prior angiogram procedure time were associated with lower likelihood of successful access. Transradial or transulnar neuroangiography through an occluded radial or ulnar artery is safe and feasible by traversing the occlusion into the brachial artery with a 23-cm sheath. Repeat catheterization is most successful in patients with an arterial occlusion <6 months old. This technique is important in patients who have limited options for arterial access, avoiding access site complications inherent in transfemoral access, and in patients who specifically require radial or ulnar artery access.

A possible mechanism and predictors of forming looped guidewire between the right subclavian and brachiocephalic artery during coronary angiography with right radial artery access: An original paper.

Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with right radial artery (RtRA) access. We called this occurrence a looped guidewire at the brachiocephalic artery (looped GW at BA). It is associated with difficulties in catheter manipulation. This study aimed to assess the predictors of forming a looped GW at the BA. We examined 175 (mean age, 71.3 ± 9.5 years; 74.9% men) consecutive patients who underwent elective CAG with the RtRA access. Looped GW at the BA was defined as a loop-like appearance of the 0.035-inch GW between the right subclavian and brachiocephalic artery on a frontal view or left anterior oblique. To identify the predictors of looped GW at BA, patient characteristics and examination data obtained before CAG were compared between patients with and without looped GW at the BA. The prevalence of looped GW at BA was 10.9%. The cardio-ankle vascular index (CAVI), which reflects arterial stiffness, was significantly different in patients with or without looped GW at BA (9.8 ± 1.0 vs. 8.9 ± 1.5, p = 0.0092). The area under the receiver-operating characteristic curve of CAVI to predict looped GW at BA was 0.745, with 0.94 sensitivity and 0.57 specificity in a cutoff point of CAVI ≥9.0. Looped GW at BA can be ruled out by CAVI and is associated with high arterial stiffness.

Assessing lead curtains’ impact on radiation protection in coronary interventions

The objective of this investigation is to assess the impact of supplementary lead curtains on the reduction of radiation dose exposure to operators during coronary interventional procedures. Seven standard positions during coronary angiography (foot, right foot, head, left foot, left lateral, left head, and right lateral) were simulated on a standard anthropomorphic phantom with radial artery access. Measurements were taken at two different heights, 125 cm and 155 cm, and dosimeters were used to measured surface incident dose rates for the first and second operators, both with and without additional lead curtains at various positions. Each position was measured 20 times, and arithmetic means were computed. A t-test was utilised to compare dose rates with and without supplementary lead curtains, as well as dose rates with additional lead curtains at varying heights. The finding indicate that the dose rates of the first operator with supplementary lead curtains were not significantly lower compared to those without, except for the 125 cm head and left foot positions and the 155 cm head position with the additional lead curtain edge 10 cm below the umbilical level (t umbilical = 0.9, 0.4, 0.5, P > 0.05). The dose rates of the second operator with additional lead curtains were significantly lower than those without, with statistically significant differences (P < 0.05). The arithmetic mean dose rates for the first and second operators at each position were lowest when the upper edge of the additional lead curtain was situated 10 cm above the umbilical level. Employing supplementary lead curtains during coronary interventions effectively reduces radiation doses received by operators. The protective effect is enhanced when the additional lead curtain is closer to the irradiation field. Hence, it is recommended that additional curtains be employed judiciously, while ensuring that clinical procedures are not impeded, in order to effectively mitigate the radiation exposure of operators.

Distal radial artery access for the treatment of complications after ulnar artery catheterization

Objective: to study the effectiveness of the distal radial artery access in the treatment of complications after ulnar artery catheterization. Material and methods. We analyze the outcomes of 1558 catheterizations of the ulnar arteries. Less than 1% of local hemorrhagic complications and 1.5% of post-catheterization occlusions of the ulnar artery were revealed after ulnar artery catheterization, Results. One half of the patients with hemorrhagic complications after ulnar artery catheterization underwent conservative treatment (mechanical compression of the site of complication), the rest of patients underwent surgical treatment. Positive effect was achieved in all patients who underwent endovascular treatment for post-catheterization hemorrhagic complications. In 50% of cases, recanalization of post-catheterization ulnar artery occlusion via the distal radial access was effective. In 1 patient after recanalization of post-catheterization ulnar artery occlusion using the distal radial artery access, the occlusion of radial artery in wrist segment occurred, with preserved blood flow in radial artery of the forearm. Conclusion. Distal radial artery access for correction of post-catheterization complications in ulnar artery is a feasible and safe method. Keywords: distal radial access, ulnar artery, radial artery, occlusion

Managing Transradial Artery Access Complications During Coronary Intervention: Three Case Reports

Transradial access (TRA) has grown in popularity recently. It has postprocedural percutaneous coronary intervention success rates that are similar to transfemoral access. TRA coronary angiography is associated with fewer vascular and bleeding complications, earlier ambulation, greater postprocedural comfort and better cost-effectiveness. Coronary heart disease has become the most prevalent cardiovascular disease, making TRA the best option for undergoing coronary angiography or percutaneous coronary intervention. It is associated with fewer vascular and bleeding complications than the transfemoral approach. However, TRA is associated with several intraprocedural difficulties during coronary angiography or percutaneous coronary intervention, such as radial artery spasm, perforation and catheter kinking. Operators must recognise the potential vascular complications associated with radial artery access. This article describes various techniques to help manage complications, leading to a successful procedure.

Long-Term Survival of Irish STEMI Patients Treated With Primary PCI via Femoral Versus Radial Arterial Access

Long-Term Survival of Irish STEMI Patients Treated With Primary PCI via Femoral Versus Radial Arterial Access

Preliminary Study on Retrograde Recanalization of Radial Artery Occlusion Through Distal Radial Artery Access: a Single-Center Experience.

Radial artery occlusion (RAO) is an unresolved complication after transradial artery (TRA) puncture. The aim of this observational study was to assess the feasibility and safety of retrograde recanalization of RAO through distal transradial access (dTRA). From June 2021 to March 2022, 28 consecutive patients with successful puncture and intubation through the dTRA in the anatomical snuffbox and RAO confirmed by angiography were enrolled. Among the 28 patients, 27 (96.4%) patients with RAO were successfully retrogradely recanalized through the dTRA and successfully underwent coronary angiography or coronary intervention. After the procedure, only 1 (3.7%) patient developed a forearm hematoma, and there were no other bleeding complications or nerve disorders. DTRA is a safe and feasible approach for retrograded recanalization of RAO, with a high procedure success rate and few complications.

Predicting Surgical Coronary Disease Prior to Invasive Coronary Angiography to Inform Selective Avoidance of Radial Artery Access and Preserve it for Use as a Bypass Graft

Predicting Surgical Coronary Disease Prior to Invasive Coronary Angiography to Inform Selective Avoidance of Radial Artery Access and Preserve it for Use as a Bypass Graft

Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention.

Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.

Clinical and Radiographic Predictors of Successful Coronary Angiography Through Right Radial Artery Access.

Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated with a higher diameter of the aortic knuckle (Group IV, 4.09 ± 1.32 cm versus Groups I, II and III combined, 3.26 ± 0.98 cm; p=0.015) and the width of the mediastinum (Group IV, 8.96 ± 2.88 cm versus Groups I, II and III combined, 7.28 ± 1.78 cm; p=0.009). The cut-off value for prominent aortic knuckle was 3.55 cm (sensitivity 70% and specificity 67.35%) and the width of mediastinum was 6.59 cm (sensitivity 90% and specificity 42.86%). Conclusion: Radiographic prominent aortic knuckle and wide mediastinum are valuable clinical parameters and useful predictors for transradial access failure caused by tortuosity of the right subclavian/brachiocephalic arteries or aorta.

Alternative (Transulnar or Distal Radial) Arterial Access for Chronic Total Occlusion Percutaneous Coronary Intervention (Subanalysis from the Minimalistic Hybrid Approach Algorithm Registry)

The transradial approach (TRA) has become the primary choice for percutaneous coronary intervention (PCI); however, it may not be always feasible because of clinical and/or technical challenges. Alternative forearm accesses, such as transulnar approach (TUA) and distal radial approach (dTRA) may allow maintaining a wrist approach for the procedure, avoiding the femoral artery. This issue is particularly relevant in patients who underwent multiple revascularizations, such as those with chronic total occlusion (CTO) lesions. This study aimed to evaluate whether the use of TUA and/or dTRA is comparable with TRA in CTO PCI using a minimalistic hybrid approach algorithm, which limits the number of accesses used to minimize vascular access complications. Patients with CTO PCI treated solely through a fully alternative approach (TUA and/or dTRA) were compared with those treated solely through a standard TRA approach. The primary efficacy end point was procedural success, whereas the primary safety end point was the composite of major adverse cardiac and cerebral events and vascular complications. Of 201 CTO PCIs attempted, 154 procedures were considered for analysis (standard, n = 104, alternative, n = 50). Alternative and standard groups demonstrated comparable rates of both procedural success (92% vs 94.2%, p = 0.70) and primary safety end point (4.8% vs 6.0%, p = 0.70). Of interest, 7 French guiding catheters were more frequently used in the alternative group (44% vs 26%, p = 0.028). In conclusion, CTO PCI after minimalistic hybrid approach by way of alternative forearm vascular accesses (dTRA and/or TUA) is feasible and safe to perform, compared with CTO PCI by way of standard TRA.

Practice Pattern Variation in Adoption of New and Evolving Percutaneous Coronary Intervention Procedures.

Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible drivers of PCI procedure-use variability is key for efforts aimed at establishing more uniform practice. Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data were used to estimate a proportion of variation attributable to hospital-, operator-, and patient-level factors across (a) radial arterial access, (b) intravascular imaging/optical coherence tomography, and (c) atherectomy for PCI. We used random-effects models with hospital, operator, and patient random effects. Overlap between levels generated cumulative variability estimates greater than 100%. A total of 445 operators performed 95,391 PCI procedures across 73 hospitals from 2011 to 2018. The rates of all procedures increased over this time. 24.45% of variability in the use of radial access was attributable to the hospital, 53.04% to the operator, and 57.83% to patient-level characteristics. 9.06% of the variability in intravascular imaging use was attributable to the hospital, 43.92% to the operator, and 21.20% to the patient. Lastly, 20.16% of the variability in use of atherectomy was attributed to the hospital, 34.63% to the operator, and 57.50% to the patient. The use of radial access, intracoronary imaging, and atherectomy is influenced by patient, operator, and hospital factors, but patient and operator-level effects predominate. Efforts to increase the use of evidence-based practices for PCI should consider interventions at these levels.

ORBI Risk Score as a predictor of in-hospital mortality and long-term outcomes in patients with ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction ST-elevation myocardial infarction (STEMI) encompasses a heterogeneous group of patients with distinct prognoses. In worse clinical scenarios with the development of cardiogenic shock (CS), mortality may ascend to 40%. Observatoire Régional Breton sur l'Infarctus risk score (ORBIs) was developed to predict the development of in-hospital CS in patients with STEMI treated with primary percutaneous coronary intervention (PCI). Aim To validate ORBI score as a predictor of in-hospital mortality (IHM) and long-term outcomes in STEMI. Methods Retrospective analysis of 296 patients admitted for STEMI and treated with PCI. Patients presenting with CS at admission were excluded. ORBIs evaluates the presence of 11 variables: age &amp;gt;70 years, prior stroke/transient ischemic attack, cardiac arrest upon entry, anterior STEMI, first medical contact-to-PCI delay &amp;gt;90 min, Killip class, heart rate &amp;gt;90/min, a combination of systolic blood pressure &amp;lt;125 mmHg and pulse pressure &amp;lt;45 mmHg, glycemia&amp;gt;10 mmol/L, culprit lesion of the left main coronary artery, and post-PCI thrombolysis in myocardial infarction flow grade &amp;lt;3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7 points), low-to-intermediate (8-10 points), intermediate-to-high (11-12 points), and high (≥13 points). The Mann-Whitney U test was used for median comparison between groups. Kaplan-Meier survival plots were used to evaluate the predictive power of ORBIs on INM and on 12-month cardiovascular events (12MH). Results Mean age was 63,9±13 years; 75% were men. 11% had a history of coronary artery disease, and 8% had been submitted to PCI previously. Mean LVEF was 54±12%. 69% had radial artery access. Left anterior descending artery disease was present in 68% of patients. Mean time since beginning of symptoms and hospital admission was 369±492 minutes. Mean duration of hospitalization was 5,68±3,5 days. ORBIs was calculated, and the population was divided into 2 groups: 45% were included in low and low to intermediate risk group (LR) (n=134), and 55% in intermediate to high- and high-risk group (HR). IHM was 3,7%. HR ORBIs was significantly associated with in-hospital mortality (6,2% vs 0,7%; p&amp;lt;0,01; OR 8,8 IC 95% 1,1;69,7). HR ORBIs was also significantly associated with long-term events (mortality and hospitalizations) (15% vs 6%; p&amp;lt;0,01). In univariate analysis, HR group showed significantly different LV ejection fraction (53,6±14,3 vs 61,0±13,1; p&amp;lt;0,01), troponin I at admission (33,3±94,12 vs 15,2±41,9; p&amp;lt;0,01), BNP (424,9±533,4 vs 194,1±170,1; p&amp;lt;0,01), duration of hospitalization (6,1±3,1 vs 5,2±3,9; p&amp;lt;0,01) and age (68,2±12,7 vs 58,9±11,5; p&amp;lt;0,01). Conclusion Higher ORBIs is associated with increased mortality in patients with STEMI. ORBIs may be a simple predictive model for short and long-term mortality and cardiovascular events in STEMI patients.

C-25 | Radial and Ulnar Artery Access for Peripheral Vascular Intervention: A Single Center Experience

Radial artery access has been increasingly utilized for coronary procedures due to lower rates of access complications, improved patient satisfaction, and shorter length of hospital stay. However, limited data are available for peripheral vascular intervention (PVI) with a reported percentage of 2% as per most report. A retrospective review of consecutive patients who underwent PVI via radial or ulnar artery access from February 2020 to September 2022 at a single institution was performed. Baseline patient, procedural, and follow-up data were ascertained from a prospectively maintained institutional database. Among 153 patients, 165 procedures were performed, 94.54% (156/165) for therapeutic purposes and 5.45% (9/165) for diagnostic purposes. Patient and procedural characteristics and outcomes are summarized in Table 1. Procedural access was obtained through the right radial artery (157/165; 95.15%), left radial artery (4/165; 2.42%), and right ulnar artery (4/165; 2.42%) using an R2P Destination Slender sheath. Conversion to femoral access occurred in 8 cases (4.84%) due to arterial spasm, arm pain, and non-crossable lesions. There were no perioperative deaths, post-operative bleeding events requiring transfusion, or pseudoaneurysms, but there were 7 access-site hematomas, which did not require blood transfusion, surgical intervention, and did not prolong hospital stay. Peripheral vascular intervention performed via radial artery access is safe and feasible and allows for simultaneous bilateral and multilevel intervention.

LB-2 | Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention: 1-Year Results of The DIPRA study

LB-2 | Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention: 1-Year Results of The DIPRA study

E-45 | Coronary Catheterizations Using Distal Versus Conventional Radial Artery Access: A Systematic Review of Randomized Control Trials

E-45 | Coronary Catheterizations Using Distal Versus Conventional Radial Artery Access: A Systematic Review of Randomized Control Trials

Efficacy and Safety of Coronary Intervention Via Distal Trans-Radial Access (DTRA) in Patients with Low Body Mass Index

Background: The distal transradial approach (dTRA) is anticipated to improve the benefits of transradial availability, hemorrhagic incidents and the occurrence of radial artery occlusion (RAO) with the dTRA is uncertain. The aim of this study to investigate the puncture time rate, homeostasis and radial artery occlusion related to low BMI in distal artery access (dTRA) vs conventional radial artery access (cTRA). Study design: This cross-sectional study was carried out at NICVD, Nawabshah, for the duration of six months from July 2022 to December 2022. Materials and Methods: The total participants were 160 who diagnosed coronary artery disorder and include 75 participants in dTRA and 85 participants in cTRA. The age group were included &gt;21 years. The demographic data, surgical methods, catheterization, procedure-related data, procedures of puncture, ultrasound follow up and BMI were recorded. All data was analyzed by SPSS 22 version. Results: The mean age of participants in dTRA group was 72.0±10.1 years and cTRA group was 73.0±18.0 years. In gender, age and BMI were non-significant in both groups. The crossover rate, puncture time, one needle puncture rate and radial artery occlusion were shown significantly change in dTRA and cTRA group, p=0.005. Conclusion: Distal radial access is a new facility for cardiovascular interventions that provides several benefits over prior links. The key benefits would be less arterial blockage and faster hemostasis. When compared to traditional radial artery access, the dTRA may be a viable and reliable connectivity site for both diagnostic and interventional coronary methods, with a decreased prevalence of RAO, high crossover rate and time needed for hemostasis. Keywords: Distal transradial artery (dTRA); conventional transradial artery (cTRA); Radial artery occlusion (RAO)

Traditional versus distal radial access for coronary angiography: a meta-analysis of randomized controlled trials.

Radial artery occlusion (RAO) is a well known complication that occurs after traditional radial artery (TRA) intervention and limits the radial artery as a future access site, as well as an arterial conduit. Distal radial artery (DRA) access has emerged recently as an alternative approach with a potential lower incidence of RAO. Database search of Pubmed/MEDLINE, Cochrane Library, and EMBASE was conducted by two authors from inception through 1 October 2022. Randomized trials that compared TRA with the DRA approach to perform coronary angiography were included. Two authors extracted pertinent data into predefined data collection tables. The risk ratios and 95% confidence intervals (CIs) were reported. Eleven trials were included (5700 patients) in the study. The mean age was 62.0 ± 10.9 years. Compared with DRA, vascular access through the TRA was associated with a higher incidence of RAO (risk ratio 3.05, 95% CI, 1.74-5.35, P < 0.01); however, arterial access by using the TRA was associated with a lower incidence of access failure leading to a crossover compared with the DRA approach (risk ratio 0.35; 95% CI, 0.21-0.57, P < 0.01). The incidence of radial artery spasm and access site-associated hematoma was not significant in the group treated with TRA compared with the DRA approach (P > 0.05). The DRA approach was associated with a lower incidence of RAO compared with the TRA approach but this was at the expense of a higher crossover rate.

Clinical Characteristics and Outcome of Percutaneous Coronary Intervention in Yemeni Patients.

Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings.