Radial Artery Spasm Research Articles

Incidence Rate and Risk Factors of Radial Artery Spasm during Transradial Coronary Angiography

Background: Radial artery spasm (RAS) is one of the most common complications of radial coronary angiography. Several demographic and clinical factors increase the risk of RAS in this procedure. We aimed to evaluate the effect of various risk factors on the incidence and severity of RAS in radial coronary angiography. Methods: This cross-sectional study was performed on 120 patients who were randomly selected from candidates referred to Shahid Modarres Educational Medical Center for coronary angiography by the radial method. After angiography, radial arteriography was performed to diagnose spasms. The association of some demographic and clinical factors with the incidence and severity of RAS was evaluated. Results: 35 of the 120 patients (29.16%) developed RAS during angiography. Shorter height, shorter radius bone length, less radial artery diameter, longer procedure length, diabetes mellitus, more catheters used, and female sex were significantly associated with higher incidence. The predictive power of these factors for the occurrence of spasms was very good with AUC=0.88. Age, shorter height, higher body mass index, smaller radial artery diameter, longer procedure time, diabetes mellitus, failure of initial effort for puncture, number of catheters used, and female sex were significantly associated with the severity of spasms. Conclusions: The incidence or severity of spasms during the procedure can be reduced by examining the available risk factors for every patient before deciding to perform angiography.

Transdermal Nitroglycerin Patch as a Potential Pretreatment to Prevent Radial Artery Spasm During Transradial Cardiac Catheterization.

A recent guideline has recommended the radial artery as the access site for coronary catheterization due to lower risk of bleeding and vascular complications. However, the transradial approach is not necessarily easy for interventionalists due to the smaller vessel diameter and more frequent occurrence of vasospasm induced by the procedure. By using the measurement in ultrasound, a previous study demonstrated that subcutaneous nitroglycerin injection at the radial artery puncture site dilated the radial artery, and that a patch was also easier and less invasive. The current case suggests the applicability of a nitroglycerin transdermal patch to prevent vasospasm via local transdermal absorption into the arterial wall; its use may lead to a higher success rate for the transradial approach, especially in patients who had experienced radial artery vasospasm.

Intractable spasm in a hypoplastic brachioradial artery during coronary angiography. A last chance before surgery

For the past several years coronary angiography through radial artery has been preferred vascular access over femoral artery due to the favorable outcomes. However radial access has also rare drawbacks. One of the main complications of radial approach is vascular spasm. Although radial spasm can easily be resolved with various intervention, rarely it may be intractable in particular anatomic variations. These patients might be needed advanced treatment methods to overcome vasospasm. In this paper we report an intractable spasm in a hypoplastic radial artery during angiography which could only be resolved by neuraxial blockage after failure of conventional treatments.

Left Transradial Neurointerventions Using the 6-French Simmons Guiding Sheath: Initial Experiences with the Interchange Technique

The transradial approach using a Simmons-shaped catheter has been increasingly used for diagnostic cerebral angiography and neurointervention. In the transradial approach for neurointervention, the right radial artery is mainly used. However, in interventional cardiology, there are apparent clinical benefits with the left transradial approach for right-handed patients. To our knowledge, no studies have reported on neurointervention with the routine use of the left transradial approach. We therefore devised a novel technique for cases with an unachievable form of the Simmons shape using the standard technique, which we named the "interchange technique." The purpose of this study was to evaluate the technical feasibility of the left transradial neurointervention. This study is a retrospective review of our prospective database of consecutive patients who underwent a left transradial neurointervention, using a 6-French Simmons guiding sheath, performed from January through April 2021. The outcome variables studied were successful catheterization and procedure-related complications. Twenty-one patients underwent a left transradial neurointervention including cerebral aneurysm coiling, carotid artery stenting, and meningioma embolization. The Simmons shape could not be formed with the standard technique for 3 patients, for whom we successfully formed the Simmons shape with our new interchange technique. The procedure was completely achieved in all 21 patients. No patients required crossover to the right radial or femoral arteries, and there were no radial artery spasms or occlusions or any procedural complications. The left transradial approach for neurointervention is a technically feasible, safe, and effective alternative while providing more comfort to right-handed patients.

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis.

BACKGROUNDThe traditional radial approach (RA) is recommended as the standard method for coronary angiography (CAG), while a distal RA (DRA) has been recently used for CAG.AIMTo assess the efficacy and safety of the DRA vs RA during CAG.METHODSThe following databases were searched through December 2020: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.RESULTSThree randomized control trials and 13 registered trials were identified. The two approaches showed similar successful cannulation rates [risk ratio (RR) 0.90, 95% confidence interval (CI): 0.72-1.13]. The DRA did not decrease RAS (RR 0.43, 95%CI: 0.08-2.49) and RAO (RR 0.48, 95%CI: 0.18-1.29). Patients with the DRA had a shorter hemostasis time in comparison to those with the RA (mean difference -6.64, 95%CI: -10.37 to -2.90). The evidence of certainty was low.CONCLUSIONFor CAG, the DRA would be safer than the RA with comparable cannulation rates. Given the limited data, additional research, including studies with standard protocols, is necessary.

Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access.

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

Comparison between Trans-Radial Versus Trans-Femoral Arterial Access in Primary Percutaneous Coronary Intervention

Background: Coronary catheterization is usually performed via the trans-femoral approach. Trans-radial access offers advantages in comparison with trans-femoral access, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization, Aim and objectives: the aim of the study was to compare 30 days outcome between radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI), Subjects and methods: this was a Prospective, randomized, open-label, double-arm, single center study, that was conducted on 120 STEMI patients; subdivided randomly into 2 groups. Group A (60 patients) had Primary PCI through femoral access; Group B (60 patients) had Primary PCI through radial access, Results: Hospitalization time in group (I) was ranged between 3–8 days with mean± S.D. 5.35±1.686 days while in group (II) was ranged between 5–10 days with mean± S.D. 7.32±1.751 days. There were statistically significant differences between groups, and Complications in group (I) showed that 9(15.0%) had access site complication, 4(6.7%) had hematoma, 2(3.3%) had Pseudoaneurysm and 7(11.7%) had Radial artery spasm while in group (II) 6(10.0%) had Access site complication. There was no statistically significant difference between groups, Conclusion: trans-radial approach is an equally effective approach as trans-femoral approach similar success and complication rates.

Effect of intra-arterial vasodilator administration during radial artery access on systemic blood pressure in patients receiving moderate sedation

The hemodynamic effects of intra-arterial vasodilator administration for the prevention of radial artery spasm during transradial access have not been well characterized. This study evaluates the effect of intra-arterial Verapamil and Nitroglycerine administration on systemic blood pressure and its correlation with timing of moderate sedation administration. Institutional review board approval was granted. Patients who underwent transradial access from 4/2018 to 4/2019 and received both intra-arterial vasodilators and moderate sedation were identified and their electronic medical records reviewed. Patients were divided into three cohorts based on the timing of sedation and intra-arterial vasodilator administration. Decrease in systolic blood pressure (SBP) was expressed as means with standard deviation which were then compared using Student's t-test. A total of 84 patients who met inclusion criteria demonstrated an overall mean decrease in SBP of 16.45 mmHg ± 15.45 mmHg. Patients receiving sedation and intra-arterial vasodilators within their expected peak SBP effect times had similar SBP change following the intra-arterial vasodilators as those in whom the interval was greater than 10 min (4.2 mmHg; 95% CI (-4.11 to 12.52), p = 0.3171). Two patients experienced asymptomatic hypotension. Patients undergoing transradial access for procedures utilizing moderate sedation can safely receive intra-arterial Verapamil and Nitroglycerine for prevention of radial artery spasm.

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis.

A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31-069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37-1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48-1.63, p = 0.001, I2 = 0%, respectively). Only eight case-control studies met inclusion criteria. This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

Vascular Complications of Transradial Access for Cardiac Catheterization

Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.

Transradial Access: A Comprehensive Review

Transradial access (TRA) via the left radial artery is an alternative to traditional transfemoral access for catheter-based procedures that is becoming increasingly more relevant in all types of arterial vascular interventions. First investigated in the realm of cardiology, TRA has been proven to provide many benefits (such as lower complication rates, lower cost, and improved patient comfort during and after the procedure) when compared with traditional femoral access while maintaining efficacy. This article provides an in-depth summary of the technical aspects of radial access while incorporating more recent data to explain patient preference for TRA, and the ways that TRA can improve peri-procedure workflow and compensation. It also describes potential complications, such as radial artery spasm, difficult anatomic variants and radial artery occlusion, and then gives techniques for mitigating and treating these complications. The article explains why TRA has become an important option for vascular and interventional radiology physicians, and why it is likely that this will continue to grow in relevance.

Contemporary Use of Radial to Peripheral Access for Management of Peripheral Artery Disease

Compared with femoral access, transradial access for percutaneous vascular intervention has demonstrated several advantages, including lower risks of access site complications, faster patient recovery time, and lower health care costs. This has led to a growing interest in utilization of transradial access as the primary access site for certain peripheral vascular interventions (PVIs). This review outlines the rationale for transradial access for PVI, offers tips on equipment selection and special procedure-specific considerations, discusses challenges and barriers to widespread utilization, and highlights the latest developments in the field. Recent development of longer balloon and stent shafts and guiding catheters have made transradial access feasible for a larger number of PVIs, including internal carotid, vertebral, subclavian, and innominate; renal, celiac, and mesenteric; and aorto-iliac and superficial femoral artery disease. Despite these advances, there remain limitations with transradial access for PVI mainly due to the small size of the radial arteries and the distance from the radial arteries to the target vessels. In addition to new devices, there has been the development of newer approaches to limit radiation exposure, prevent radial artery spasm, and avoid radial artery occlusion. The benefits of radial access for vascular interventions have been well established. With ongoing innovation and studies demonstrating effectiveness and safety of this approach, “radial first” for peripheral interventions has a bright future and may someday become the standard of care for certain peripheral interventions.

Clinical study of peripheral vascular intervention via radial artery

Objective: To discuss the safety and feasibility of transradial access (TRA) in performing peripheral arterial intervention. Methods: The clinical data of the patients underwent peripheral vascular intervention via TRA in our hospital from September 2017 to March 2019 were reviewed. The success rate of radial artery puncture and subsequent operation after puncture, and related postoperative complications within 30 days were analyzed. Results: The clinical data of 112 peripheral arterial intervention procedures via TRA performed on 106 patients were reviewed, including transcatheter arterial chemoembolization in 83 cases, bronchial arterial infusion in 4 cases, pelvic tumor embolization in 11 cases and 14 other cases. The success rate of all interventional punctures was 97.3% (109/112), the operative success rate of interventional procedures was 98.2% (107/109). The TRA operation was failed in 5 patients, who were then converted to receive the femoral artery puncture and complete successfully. The severe complication of the operation was aortic dissection (2 cases). Minor complications included 2 cases of radial artery occlusion, radial artery spasm, arm pain and puncture point hematoma for each case. The severe complication and the minor complication rates were 1.8% (2/112) and 4.5% (5/112), respectively. Sixteen emergency operations were performed successfully, and no complication occurred. Conclusion: The TRA is a clinically safe and feasible approach for peripheral arterial interventional procedure.

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.

Feasibility and initial experience of left radial approach for diagnostic neuroangiography

Neuroangiography has seen a recent shift from transfemoral to transradial access. In transradial neuroangiography, the right dominant hand is the main access used. However, the left side may be used specifically for left posterior circulation pathologies and when right access cannot be used. This study describes our initial experience with left radial access for diagnostic neuroangiography and assesses the feasibility and safety of this technique. We performed a retrospective review of a prospective database of consecutive patients between April 2018 and January 2020, and identified 20 patients whom a left radial access was used for neurovascular procedures. Left transradial neuroangiography was successful in all 20 patients and provided the sought diagnostic information; no patient required conversion to right radial or femoral access. Pathology consisted of anterior circulation aneurysms in 17 patients (85%), brain tumor in 1 patient (5%), and intracranial atherosclerosis disease involving the middle cerebral artery in 2 patients (10%). The left radial artery was accessed at the anatomic snuffbox in 18 patients (90%) and the wrist in 2 patients (10%). A single vessel was accessed in 7 (35%), two vessels in 8 (40%), three vessels in 4 (20%), and four vessels in 1 (5%). Catheterization was successful in 71% of the cases for the right internal carotid artery and in only 7.7% for the left internal carotid artery. There were no instances of radial artery spasm, radial artery occlusion, or procedural complications. Our initial experience found the left transradial access to be a potentially feasible approach for diagnostic neuroangiography even beyond the left vertebral artery. The approach is strongly favored by patients but has significant limitations compared with the right-sided approach.

A novel technique to perform cerebral angiography via the left radial approach: An 80 patients series

PurposeTo demonstrate that left radial access for diagnostic cerebral angiography with Extra backup and 4F vertebral catheters is feasible and safe. Materials and methodsThis study is a retrospective review of our prospective database on left radial access for cerebral angiography procedures, using an extra backup catheter associated with a 4Fr vertebral catheter, performed between March and September 2019. Patient demographics, procedural and radiographic metrics as well as clinical data were recorded. ResultsSeventy five patients with mean age of 51...years (range 21...73) underwent 80 cerebral angiographies. An average of four vessels were catheterized and mean fluoroscopy times per subject and vessel were was of 13.9 and 3.3...min, respectively. One patient required crossover to transfemoral access because of radial artery spasm. There were one asymptomatic distal radial artery occlusion and one patient presenting with asymptomatic skin blanching area on the forearm, just proximal to the tip of the sheath, that spontaneously resolved within an hour. ConclusionDiagnostic cerebral angiography via left radial access is feasible and safe and allows to preserve the right radial access for future neurointerventions while providing more comfort to the right handed patient.

COMPARISON OF INTRAVENOUS VERSUS INTR-ARTERIAL HEPARIN FOR THE PREVENTION OF RADIAL ARTERY OCCLUSION DURING TRANSRADIAL CORONARY ARTERY CATHETHERIZATION

Objective: To determine the relative efficacy of intravenous heparin as compared to intra-arterial heparin used during transradial coronary angiography for the prevention of radial artery occlusion.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Study was conducted at the Department of Cardiology, AFIC/NIHD Rawalpindi, Pakistan, from Jul 2019 to Dec 2019.&#x0D; Methodology: A total number of 144 patients were considered for the study using the consecutive sampling technique who were undergoing diagnostic coronary angiography. Patients were divided into the intra-arterial group (n=72) who received 50 IU/kg of unfractionated heparin (maximal dose 5,000 U) intra-arterially, and an intravenous group (n=72) received the similar dose through intravenous route. All patients were administered 100 mcg of nitroglycerin to minimize radial artery spasm. Coronary Angiography was performedusing a 6F introducer sheath and diagnostic catheters. Early radial artery occlusion (RAO) at 24 hours after the procedure was detected by performing the plethysmographic (reverse Barbeau’s) and doppler USG evaluation. Chronic RAO was assessed 30 days after the procedure by performing the same tests. Data was collected through a predesigned proforma and analyzed using SPSS 23. A p-value of less than 0.05 was considered as significant.&#x0D; Results: Early RAO was found in 4 (5.6%) of the patients from the intra-arterial groupand 5 (6.9%) of the intravenous group. The difference was found to be statistically insignificant (p-value 0.731). Chronic RAO was observed in 3 (4.4%) of the intra-arterial group as compared to 4 (6%) of the intravenous group. This difference was also statistically insignificant (p-value 0.683) for chronic RAO.&#x0D; Conclusion: Intra-arterial and intravenous heparin administration providedsimilar efficacy to prevent RAO.

A randomized trial of flow-mediated dilation to prevent radial artery spasm during transradial approach

Background Although transradial approach has been increasingly preferred for percutaneous coronary interventions, radial artery spasm (RAS) is still one of the major disadvantage. Flow-mediated dilation (FMD) is a well-known method for assessing endothelial function through dilation. The aim of this study was to investigate the efficacy of prepuncture flow mediated dilation in preventing RAS during transradial approach. Methods The present study prospectively included 222 consecutive patients who underwent transradial coronary intervention. Patients were 1:1 randomized into two groups who underwent prepuncture FMD and who did not (FMD [+] and FMD [-], respectively). Results In FMD [+] group the incidence of RAS was lower (5.4% vs 16.2%, p=0.009). Multivariate logistic regression analysis demonstrated that female sex, more than two catheter usage and transradial approach without prepuncture FMD independently predicted RAS (odds ratio (OR): 4.66, 95% confidence interval [CI]: 1.8-12.06, p=0.001, OR: 5.73, 95%CI: 2.01-16.39, p=0.001, and OR: 5.01, 95% CI: 1.74-14.48, p=0.003; respectively). However, access site crossover number was very low in both groups and not different between groups. Conclusions Prepuncture FMD can significantly reduce RAS during transradial coronary interventions. Thus, prepuncture FMD can be used as a simple adjunctive method to prevent RAS.

Novel combined topical gel of lidocaine–verapamil–nitroglycerin can dilate the radial artery and reduce radial pain during trans-radial angioplasty

IntroductionRadial approach for coronary angioplasty is accepted by many specialists in medical centers around the world. The use of radial access is associated with fewer vascular complications and the same success rate in comparison with traditional femoral access. Radial artery spasm is one of the main concerns in this method. The small size of the radial artery and high density of alpha-1 adrenergic receptors in this artery can accelerate the spasm. The objects of this study were to evaluate whether the combined topical gel of lidocaine–verapamil–nitroglycerin could dilate the radial artery and reduce patient pain and sympathetic response during radial puncture.MethodsPatients undergoing elective trans-radial angioplasty were randomized to either placebo or therapeutic gel group in single-center, double-blind study. Placebo or therapeutic gel applied 1 cm proximal to the radial styloid process. Radial artery size was measured by ultrasound. Radial pain was reported by the visual analog scale (VAS) and the sympathetic response was assessed by changes in systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR). The incidence of spasm was defined by the radial artery spasm score.Results60 patients (30 patients in each group) participated in this study. A significant increase in the size of the radial artery was observed in the group receiving therapeutic gel compared to the placebo group (mean diameter, mm: 2.95 ± 0.48 vs. 2.54 ± 0.43, p = 0.001; area, cm2: 0.07 vs. 0.05, p = 0.001). During radial puncture, the radial pain intensity was significantly decreased in patients receiving therapeutic gel (4 (1–5) vs. 2 (1–2), p = 0.003). Radial artery spasm didn’t happen in any group.ConclusionBased on our results, Pre-procedural administration of combined topical gel of verapamil-nitroglycerin-lidocaine significantly increases the size of the radial artery and effectively reduces the radial pain during radial puncture in patients undergoing trans-radial angioplasty.

Hospital results of endovascular treatment of patients with Acute Coronary Syndrome (ACS) through distal radial access

Abstract Background Radial access is traditionally the first line method for percutaneous coronary interventions (PCI). However, it has its drawbacks. Recently a new distal radial approach (DRA) has been proposed. The results of using this method in patients with ACS are not defined. Aim of this study To evaluate the safety, efficacy and hospital outcomes ot treatment of patients with ACS using DRA during PCI as compared to traditional radial access (TRA). Materials and methods A single-center randomized trial included 264 people who underwent PCI in the period from November 2018 to May 2019 at our clinic. The proportion of patients with unstable angina was 60.6% (n=160), with acute myocardial infarction 39.4% (n=104). Patients were divided into 2 groups: in the 1st gr. (n=132) was used DRA, in the control 2nd gr. (n=132) - TRA. The studied groups were comparable according to the initial clinical and angiographic data. All interventions were performed by experienced endovascular cardiologists who perform more than 300 PCI per year. Statistical methods We used a program Statistica 6.0, v. 15, Pearson's criterion, Fisher's exact test, t-test. Results During PCI, 228 drug-coated stents were implanted in 104 patients. 10 patients had access conversion during PCI: from DRA to TRA in 3 patients, to femoral access - in 4 (the total number of conversions from DRA was 5.3%), from transradial to femoral in 3 people (2.3%), and therefore in the 1st group left 125 patients for observation, in the second - 129, respectively. The average puncture time was 125.1±11.9 sec. in the 1 gr. and 58.8±8.2 sec. in the 2 gr. (p≤0.00005). There was no difference in the total execution time of PCI: 30.5±7.1 min. in the 1 gr. and 29.4±4.6 min. in the 2 gr. (p≥0.1428). The duration of hemostasis was significantly higher in the TRA group: 354.2±28.1 min. against 125.4±15.3 min. in the 1 gr. (p≤0.00005). In the DRA group, there was a lower incidence of hematomas: in 1 patient (0.8%) versus 9 (7.0%) in the TRA group (p=0.019), radial artery spasm: in 7 patients (5.6%) versus 17 (13.2%) in the 2 gr. (p=0.039) and thrombosis at the access site: occlusion radial artery was observed only in 1 patient (0.8%) in the DRA group, while in the TRA group - in 8 (6.2%), p=0.036. The frequency of Major Adverse Cardiac Events (MACE) in the studied groups at the hospital stage was similar: 2.4% of cases (n=3) in the 1st gr. and 2.3% (n=3) in the 2nd group (p=1.0). Conclusions Our one-center prospective study showed: The use of distal radial access does not extend the overall procedure time compared to transradial approach. The frequency of major complications is comparable in the two studied groups. We noted a significantly lower frequency of local complications when using DRA compared to TRA. So, distal radial approach may be an alternative to transradial access, however, large randomized trials are needed for a final conclusion. Funding Acknowledgement Type of funding source: None