Radial Catheter Research Articles

EXPERIENCE WITH DIFFERENT SINGLE-STAGE SELECTIVE ARTERIAL CATHETERIZATION PROCEDURES DURING X-RAY ENDOVASCULAR INTERVENTIONS TO REDUCE A RADIATION DOSE FOR PATIENTS

To evaluate the impact of single-stage selective arterial catheterizations during X-ray endovascular interventions to reduce obtained radiation doses in the treatment of patients. X-ray endovascular interventions were carried out in the operating room equipped with a flat detector digital angiography system (Axiom Artis dTA, Siemens Medical System). The impact of single-stage selective arterial catheterization procedures was analyzed during endovascular interventions for coronary heart disease and uterine myomas on the time course of changes in the collective effective radiation doses for patients in the period 2013 to 2015. Analysis of the findings showed that single-stage selective coronary angiography using a universal (multipurpose) radial coronary catheter and single-stage X-ray endovascular uterine artery embolization techniques could reduce collective effective doses for patients from 5.86 persons-Sv in 2013 to 1.6 persons-Sv in 2015. Different single-stage selective catheterization procedures used during endovascular interventions into the coronary and uterine arteries can reduce radiation doses for patients.

Transradial arterial access catheter knots: towards a new treatment algorithm

Transradial access for percutaneous coronary and non-coronary intervention has gained worldwide acceptance. This approach has demonstrated less bleeding and vascular events with a reduced in-hospital stay, and an improvement in clinical outcomes when compared to the traditional transfemoral approach. However, this strategy may occasionally lead to severe catheter kinking and further manipulation may be required to unravel the catheter and avoid complication. Purpose of this review article is to present the current knowledge and evidence in preventing and potentially resolving issues related to radial access catheter knots.

TCT-358 Bleeding and vascular complication rates before and after implementation of a radial coronary catheterization programme – an observational study in 12 745 patients

TCT-358 Bleeding and vascular complication rates before and after implementation of a radial coronary catheterization programme – an observational study in 12 745 patients

Short sheath benefit in radial artery injury after PCI - optical coherence tomography serial study

Transradial catheterization is the predominant access site for coronary catheterization and percutaneous coronary interventions (PCI). Previous studies have reported a high incidence of radial artery (RA) injury. The aim of this investigation was to evaluate the incidence of RA injury using last generation optical coherence tomography (OCT) intravascular imaging in a serial manner. 100 patients with a diagnosis of non-ST-elevation myocardial infarction (nSTEMI) treated by PCI were enrolled. OCT of RA was performed immediately after the index PCI. OCT was repeated 9 months later. There were 11 patients with RA injuries (11.0%) at baseline, including 3 patients with RA medial dissection and 8 patients with intimal tears. In the follow-up OCT data, the number of RA injuries was 10 (10.0%), including 7 patients with RA medial dissection and 3 patients with intimal tear. All injuries were clinically asymptomatic and there was no finding of vessel perforation. There was no significant difference between the baseline and follow-up procedure in terms of number of injuries. The study showed no significant difference between baseline and follow-up RA injury incidence. There was a higher risk of radial injury for repeated catheterization in women. The conclusion is that radial catheterization is a very safe procedure in terms of radial artery damage. This is evidenced by considerably fewer injuries compared to published studies. The use of the short radial sheath (7 cm in this study) is protective and reduces the incidence of radial injury.

Comparison of Standard Catheters Versus Radial Artery–Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access

In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of thestudy included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter wasassociated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131seconds, p=0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7Gy·cm(2), p= 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5ml, p= 0.114), and total procedure time (337 ± 382 vs 434 ± 137seconds, p= 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be switched to femoral access (3 in each group) secondary to radial artery spasm. In conclusion, the radial artery-specific catheter was shown to have significantly lower fluoroscopy times but higher failure rates compared with the standard catheters.

Gaining a New Skill With the Risk of Losing One: The Effect of Radial Catheterization

The adoption of radial catheterization has been relatively slow in the United States. This study was conducted to assess the perceived comfort level of cardiology fellows with radial catheterizations and to predict the practice patterns in the United States in the near future. A 21-question survey on cardiology fellows’ preferred cardiac catheterization access site was conducted between April and June 2015. Data on access preference and perceived competency were analyzed based on the fellow’s level of training and type of training program (university vs community). A total of 101 responses were received from a total of 250 invitations; 85 (85%) of these respondents completed all questions. Data were collected from fellows of several programs nationwide. Of the 85 respondents with complete data, 22%, 29%, and 19% were first-, second-, and third-year interventional fellows respectively. Most respondents (82%) were from university-based programs, 46.3% of respondents considered that their programs provided a balance of both radial and femoral training. Irrespective of the training year, most fellows seemed to prefer radial over femoral access. Senior fellows appeared to be equally comfortable with a femoral access approach (P = 0.03). There was no difference by training site (university vs community programs) (P = 0.921). In 2015, US cardiology fellows appear to prefer radial over femoral access for cardiac catheterizations. Although it is good to see the shift toward better radial access skills, we need to stress the importance of the femoral skills that would be necessary to keep in the armamentarium of interventional cardiologists.

CRT-200.24 Feasibility and Efficacy of Transradial Coronary Intervention in Elderly Patients with ST-segment Elevation Acute Myocardial Infarction

Transradial coronary intervention (TRI) for elderly patients with ST-segment elevation myocardial infarction (STEMI) is technically demanding because of difficulties in radial puncture and catheter advancement and poor backup support from the tortuosity of the subclavian and common carotid artery.

Systemic Inflammation after Transradial Coronary Angiogram: Statistically (But Not Clinically) Significant?

Aims: To evaluate if transradial diagnostic coronary angiogram by itself could lead to a systemic inflammation. Methods: In 96 patients with baseline hs-CRP level <5 mg/L, venous samples were obtained the day before the procedure and the day after. Coronary angiogram was performed with 4, 5 or 6 French radial access catheters. Results: Mean hs-CRP at admission was 2.3 mg/L ± 1.4. At day 2, the mean CRP level was 2.7 mg/L±1.9, with a 0.4 mg/L (17%) statistically significant elevation, p<0.0001. No radial access complication (thrombosis or hematoma) occurred. The variation of hs-CRP was positively correlated with age (r=0.20; p=0.04), elevation of creatin kinase (r=0.20; p=0.03) and negatively with amount of contrast (r=0.20; p=0.03). Conclusion: In patients with diagnostic coronary angiogram performed through radial access, there is a statistically significant elevation of the biological inflammatory response, whose clinical significance remains elusive.

Radial Interventions: Present and Future Indications.

Since its first introduction, radial access for diagnostic and interventional cardiovascular procedures has progressively evolved with advances in understanding, capabilities, and ease of operation. Numerous studies have demonstrated its safety, efficacy, and cost-effectiveness. Overall, radial catheterization is a valid alternative to the femoral approach with additional benefits of shorter length of hospital stay and reduced patient costs when performed by experienced interventionists. Moreover, with reduced rates of access site complications and enhanced patient satisfaction, the transradial approach has emerged as the preferred vascular access route for most coronary interventions, even in cases of acute myocardial infarction.

Magnetic resonance imaging compatible remote catheter navigation system with 3 degrees of freedom.

To facilitate MRI-guided catheterization procedures, we present an MRI-compatible remote catheter navigation system that allows remote navigation of steerable catheters with 3 degrees of freedom. The system consists of a user interface (master), a robot (slave), and an ultrasonic motor control servomechanism. The interventionalist applies conventional motions (axial, radial and plunger manipulations) on an input catheter in the master unit; this user input is measured and used by the servomechanism to control a compact catheter manipulating robot, such that it replicates the interventionalist's input motion on the patient catheter. The performance of the system was evaluated in terms of MRI compatibility (SNR and artifact), feasibility of remote navigation under real-time MRI guidance, and motion replication accuracy. Real-time MRI experiments demonstrated that catheter was successfully navigated remotely to desired target references in all 3 degrees of freedom. The system had an absolute value error of [Formula: see text]1mm in axial catheter motion replication over 30mm of travel and [Formula: see text] for radial catheter motion replication over [Formula: see text]. The worst case SNR drop was observed to be [Formula: see text]3%; the robot did not introduce any artifacts in the MR images. An MRI-compatible compact remote catheter navigation system has been developed that allows remote navigation of steerable catheters with 3 degrees of freedom. The proposed system allows for safe and accurate remote catheter navigation, within conventional closed-bore scanners, without degrading MR image quality.

OP‐9 MODULATION OF THE RECTOANAL INHIBITORY REFLEX IN PATIENTS WITH MYELOMENINGOCELE WITH AND WITHOUT BLADDER AUGMENTATION

Introduction:Some patients with myelomeningocele need bladder augmentation (augmentation cystoplasty). The aim of this study was to evaluate the relationship between the bladder augmentation and the rectoanal inhibitory reflex (RAIR) modulation in patients with myelomeningocele. The modulation of the anorectal inhibitory reflex in accord the use of oxybutynin chloride was also evaluated.Methods:It is a cross‐sectional and comparative study. We studied a convenience sample consisting of 24 children and adolescents with myelomeningocele aged between 4 and 18 years. Ten of these 24 patients had surgery to expand the bladder. Anorectal manometry of perfusion were performed with 8‐channel radial catheter (Dynamed®) in latex free protocol. The evaluation of the (RAIR) modulation was determined by inflating the balloon with 20 mL of air in rectal. The RAIR modulation was determined by duration (seconds) and amplitude (% relaxation) of RAIR.Results:RAIR was present in all the patients. The duration of the RAIR (seconds) with 20 mL and 40 mL was similar in the both groups, with or without bladder augmentation (27.11 ± 11.95; 27.37 ± 9.29; p = 0.953 and 30.32 ± 7.30; 32.08 ± 10.13, p = 0.653). The RAIR amplitude with 20 mL and 40 mL was higher in the patients with bladder augmentation than in patients without bladder augmentation (63.87 ± 24.58; 82.31 ± 15.94, p = 0.036 and 68.06 ± 14.80;88.93 ± 16.31, p = 0.004). The patients who used oxybutynin chloride presented higher amplitude (% relaxation) in relation those did not used this drug, with 20 mL (80.91 ± 15.37 and 65.21 ± 25.73; p = 0.074) and 40 mL (85.78 ± 15.96 and 73.05 ± 19.29; p = 0.084), however, the statistic evaluation did not reach significance.Conclusions:The RAIR modulation is different between patients with and without bladder augmentation. The use of oxybutynin chloride also appears to interfere in the RAIR, increasing its amplitude.

A New Design of a Lead-Acrylic Shield for Staff Dose Reduction in Radial and Femoral Access Coronary Catheterization.

Today's standard radiation protection during coronary angiography and percutaneous coronary interventions is the combined use of lead acrylic shields and table-mounted lower body protection. Ambient dose measurements, however, have shown that these protection devices need improvement. Using an anthropomorphic physical phantom, various scenarios were investigated with respect to personnel exposure: a) enlarging the shield b) adding a flexible protective curtain to the bottom side of the shield, and c) application of radioprotective patient drapes. For visualization of the dose reduction effect, Monte Carlo simulations were performed. The flexible curtain in contact with the patient's body reduces the ambient dose rate at the operator's position by up to (87.5% ± 7.1) compared to the situation with the bare shield. The use of both the flexible curtain and the patient drape reduces the ambient dose rate by up to (90.8% ± 7). Similar results were achieved for the assisting personnel when they were positioned next to the operator. In addition, the enlarged shield provides better protection of the head region of tall operators. Adding a flexible protective curtain to the bottom side of the shield can protect operators from high doses, especially for body parts which are not protected by lead aprons, e.g. head, and eye lenses. This may be important with respect to lower dose limits for eye lenses in future. The protective effect in real-life working conditions is still being evaluated in an ongoing clinical study. Lead acrylic shields need improvement for a better protection of head and eye lenses. An additional flexible lead curtain at the bottom of the shield can considerably reduce the operator dose. Using the additional lead curtain, lighter protection clothing can be worn. Special eye protection may be no longer needed in most applications.

Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement.

BackgroundThe purpose of the study was to assess blood flow in the upper limb arteries after prolonged catheterization with long radial artery catheters (LRC) which reach the subclavian artery compared to catheterization with standard short radial artery catheters (SRC) and a group of upper limb flow without any catheter placement (NOCATH), with both SRC and NOCATH as control groups.MethodsProspective observational study with 20 patients admitted to ICU (40 upper limbs) with LRC and/or SRC inserted >48 h for hemodynamic monitoring. More than 45 days after catheter withdrawal, patients underwent a Doppler ultrasound study of both upper limbs. Arterial flows of arms with LRC (FlowLRC) were compared with arterial flows of arms with SRC (FlowSRC) and those without any catheter (FlowNOCATH).ResultsFlow in the ulnar, brachial, and subclavian arteries did not show any significant difference between the two types of catheters. The only significant difference was in the radial arteries, showing a lower mean flow in the arms with LRC than in the arms with SRC (2.2 vs. 8.5 cc/min; p = 0.041). Flow reduction in the radial artery (74%) in the arms with LRC compared to the SRC arms showed a tendency to increase ulnar flow as a compensatory mechanism. None of the patients with LRC included in our study had any ischemic events, in spite of observing complete flow occlusion in three radial arteries (18%) from the Doppler study.ConclusionsIn this sample, the use of PiCCO long radial catheters reaching the subclavian artery did not produce chronic significant changes in brachial or subclavian flows. However, LRC produces a significant reduction in radial flow and a tendency to increase ulnar flow. When comparing these blood flow changes with those produced by SRC use, only the radial flow reduction was significantly lower, whereas the other arterial flow changes did not significantly differ.

Single Center Retrospective Analysis of Conventional and Radial TIG Catheters for Transradial Diagnostic Coronary Angiography.

Current guidelines favor the radial approach for coronary angiography. Therefore, specialty radial diagnostic catheters were designed to engage both coronary arteries with a single device. However, it is unclear if single catheters are superior to conventional catheters. A retrospective analysis was performed of consecutive right radial coronary angiographies to determine catheter use, fluoroscopy time, radiation dosage, and consumption of contrast. Procedures were performed with a single TIG catheter or conventional catheters (CONV). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded. 273 transradial procedures were performed successfully. 95 procedures were performed with CONV and 178 procedures with a TIG. Crossover to additional catheters was higher in TIG (15.2%) compared to CONV (5.3%, p = 0.02). Fluoroscopy time was comparable between CONV and TIG, without crossover (2.2 ± 1.2 min versus 2.3 ± 1.2 min; n.s.), however, greater in the case of crossover for CONV (5.8 ± 0.7) and TIG (7.6 ± 3.0; p = 0.0001). Radiation dosage was similar in CONV and the TIG, without crossover (1419 ± 1075, cGy∗cm2 versus 1690 ± 1138; n.s.), however, greater for CONV (2374 ± 620) and TIG (3733 ± 2281, p = 0.05) with crossover. Overall, the amount of contrast was greater in TIG (56 ± 13 mL) versus CONV (48 ± 3 mL; p = 0.0003). CONV femoral catheters may be the primary choice for radial approach.

A rare complication of arterio-venous fistula following coronary intervention using radial approach

Major entry site complications are rare following transradial approach. Arterio-venous fistula following radial catheterization is a very rare complication. It can occur rarely and should be evaluated. This report highlights a case of radial Arterio-venous fistula following percutaneous coronary interventions by right radial approach and good outcome with conservative management.

Do it simple: Rescue of a radial catheter stuck in axillary artery

Stuck catheters are a nightmare for all interventional cardiologists. We report a case of a successful non-invasive rescue maneuver of a stuck catheter in the right axillary artery. While performing a cardiac catheterization via the right radial artery in a 52-year-old male patient, the catheter got stuck and couldn't be removed initially. Finally a non-invasive technique of arm elevation allowed us to rescue the catheter.

Transradial approach to cardiovascular interventions: an update.

Background Since the first cardiac catheterization in 1929, the procedure has continually evolved with advances in understanding, capabilities, and ease of operation. Though historically performed by cut down of the brachial artery, cardiologists soon learned that transfemoral access was both easier to perform and more efficacious with regard to patient outcome. In the last 20 years, the transradial approach has been adopted, and is being utilized with increasing frequency. Methods We conducted a survey of literature published concerning safety, efficacy, cost-effectiveness, and global uptake of transradial catheterization with specific attention to how transradial interventions compare with transfemoral interventions. Results This review of literature indicates that when performed by an experienced interventionalist, radial catheterization is as effective as femoral catheterization and has additional benefits of shorter length of hospital stay and reduced patient costs. Transradial access is superior to transfemoral access in some, but not all, clinical scenarios; in addition, it is an effective alternative for catheterization in patients contraindicated for transfemoral procedures. Adoption of radial access in the United States is at a faster rate than previously expected, though rate of use varies drastically worldwide. Conclusion The transradial approach is an excellent option for carrying out cardiovascular interventions, and will be adopted by more cardiologists in the upcoming years.

Warfarin: Impact on hemostasis after radial catheterization

This study explores bleeding risk of warfarin patients undergoing radial catheterization. Traditionally warfarin has been held prior to catheterization due to bleeding risk; however, this practice is being reconsidered with radial access. This study examined if radial patients receiving warfarin have similar hemostasis times to those not taking warfarin. A convenience sample of patients undergoing radial catheterization was analyzed. Demographics, procedure characteristics, and pharmacologic therapies were reviewed. Hemostasis times, defined as compression band times, were compared. To exclude confounding effects of aspirin and clopidogrel, a separate analysis of band times for each medication was performed. Specifically, analysis of variance models and exact logistic regression models were used to assess means between usage or nonusage of medications (warfarin, aspirin, clopidogrel) while adjusting for other medications. Of 208 patients, 60 (29%) were taking warfarin. The breakdown of warfarin, aspirin, and clopidogrel use was as follows: 6 (3%) not taking medications; 14 (7%) warfarin alone; 88 (42%) aspirin alone; 2 (1%) clopidogrel alone; 39 (19%) both warfarin and aspirin; 52 (25%) clopidogrel and aspirin; and 7 (3%) warfarin, aspirin, and clopidogrel. No major complications occurred. Mean hemostasis times for warfarin and nonwarfarin patients were not different (118 vs. 116 min; P = 0.25). Likewise, there was no difference for aspirin (117 vs. 114 min; P = 0.70). There was a nonsignificant trend toward clopidogrel prolonging hemostasis (123 vs. 114 min; P = 0.09). There were no apparent differences in adequacy of hemostasis or duration of compression time between patients taking warfarin or not taking warfarin after controlling for antiplatelet therapy. © 2014 Wiley Periodicals, Inc.

Brachial Artery Catheterization

Although studies have compared safety and outcomes of radial artery cannulation with other arterial catheterization locations, there is insufficient information describing brachial artery catheterization. In this study, we characterized the perioperative use patterns and the complication rates associated with brachial arterial catheterization and compared these outcomes with radial artery catheterization. We performed a retrospective analysis of adult patients (age ≥18 years) undergoing surgical procedures at an academic medical center from January 1, 2008, to December 31, 2011. An institutional database containing information on anesthetic care was queried to identify all brachial artery catheterizations. Baseline characteristics, details relating to the surgical and catheterization procedures, and catheter-related complications were collected and compared with a random sample of patients receiving radial artery catheterization. We identified 858 patients receiving brachial catheterization perioperatively. An additional 3432 patients receiving radial catheterization were identified. Patients receiving brachial catheterization were more often women, had a lower body mass index, had more comorbidities, and had longer anesthetic and catheterization durations. Three vascular complications were identified in the cohort receiving brachial artery catheterization compared with 1 patient with a peripheral neuropathy in the radial artery catheterization cohort (unadjusted complication incidence [95% confidence intervals] brachial artery catheterization, 0.35% [0.12%-1.02%] vs radial artery catheterization, 0.03% [0.005%-0.16%], respectively; P = 0.030; relative risk [95% confidence interval] = 12.0 [1.7-83.4]). There were no catheter-related bloodstream infections. We found that brachial artery catheterization is used in more medically complex patients and for longer duration than radial artery catheterizations. Although the limited number of adverse outcomes precluded statistical adjustments in this investigation, the observed differences in complication rates between cannulation methods suggest that brachial artery catheterization may be a suitable alternative to radial artery catheterization in patients with complex medical comorbidities.

Computerized tomographic angiography in patients having eSVS Mesh(R) supported coronary saphenous vein grafts: intermediate term results

With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay.We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents.