Safety Of Transradial Coronary Intervention Research Articles

Radial Versus Femoral Access for Acute Coronary Syndromes.

The feasibility and safety of transradial coronary intervention was demonstrated soon after the description of the transfemoral approach, despite which the use of the femoral artery still dominates in acute coronary syndrome intervention. The advantages of using the radial artery are virtual elimination of access site complications and an important reduction in bleeding, both of which are of utmost importance to the patient with myocardial infarction. Randomised controlled trials have now documented what seems inherent; that transradial intervention should bring with it an advantage in terms of morbidity and mortality in this cohort. The potential disadvantages in terms of speed of procedure and radiation exposure are negated by operator experience. Registries have illustrated that conversion on a large scale from the femoral to the transradial approach is safe and saves lives, most convincingly so in acute coronary syndrome intervention. This review discusses the potential benefits and risks of the alternative access sites in acute patients and explores how these are borne out in the published data.

TCT-282 Feasibility and Safety of Transradial Coronary Intervention Using 6.5 French Sheathless Guiding Catheter during ST-segment Elevation Acute Coronary Syndrome (STEACS) in Patients with Small Radial Artery: A Multi Center Registry.

Background: Transradial approach during STESCA is used more frequently and is associated with reduced rate of vascular complications and mortality. However, the small size of the radial artery is sometimes a limitation of this technique. A sheathless guiding catheter is available which is 2 french smaller than the sheath and has a hydrophilic coating along its entire length. The aim of this study is to investigate the feasibility and the safety of using this sheathless catheter during STEACS treatment in patients with small radial arteries. Methods: From March 2009 to May 2013 in three french hospitals, 40 patients had a primary PCI through transradial approach using sheathless catheter after failure to introduce 6F sheath or severe frictions with 5F angiography catheter. Results: The 40 patients were 65.62 16.41 years old (40 to 91), 23 were women (57.5%). Patient baseline characteristics: 10 (25%) had a history of coronary artery disease, 18 (45%) were heavy smokers, hyperlipidaemia in 20 (50%), 15 (37.5%) had hypertension, diabetes in 7 (17.5%) and coronary family history in 5 (12.5%) patients. 12 (30%) patients had a lesion in the LAD, 22 (55%) in the RCA and 6 (15%) in the circumflex coronary artery. The average volume of product of contrast is 128.55 ml . The total number of 49 stents were used used during these procedures (20 BMS, 29 DES) with 1.2 stents/patient. Door to Balloon average time was 35.25 minutes and the procedural time was 47.64 minutes. Adjunctive devices used in this cohort included thrombus-aspiration catheters in 32 patients (80%) and the technique of kissing balloon in 7 patients (17,5%) undergoing bifurcation PCIs. One patient had an acute intra stent thrombosis treated with thromboaspiration then angioplasty with balloon only. Rotablator atherectomy was implemented in one patient for very calcified lesion. The technical success rate of the procedures using the sheathless catheter was 100% without any conversion to femoral approach. There were no radial artery site complications. Conclusions: The use of sheathless guiding catheter safely increases the feasibility of transradial approach for primary PCI.

Short- and Long-Term Follow-up of Percutaneous Coronary Intervention for Chronic Total Occlusion through Transradial Approach: Tips for Successful Procedure from a Single-Center Experience

There are limited data regarding transradial percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). To assess the feasibility and safety of transradial coronary intervention (TRI) for CTO lesions, we analyzed our experience in PCI treatment of CTO lesion through transradial approach for the past 6 years. From January 2003 to May 2009, among 134 CTO lesions, on which we performed PCI, 120 lesions were performed from transradial approach. Technical success for transradial CTO was 80%. Complication of access bleeding was zero. The most commonly selected guiding wire was Wave 3 for right coronary artery (RCA) lesions (82%) and Voda left for Left Coronary Artery (LCA) lesions (91%). The average number of wires used during procedure was 2.2 ± 0.8. Tapered wire was used in 8% of the cases, Rotablator was performed in 4.1% of cases, and Tornus catheter was performed in 12.5% of cases. The mean procedure time was 83 ± 39 minutes. The mean volume of contrast medium used was 228 ± 92 mL. There were two coronary artery perforations during procedure and one in-hospital cardiac death. Patients were followed up for 36 ± 21 months; restenosis rate was 19.5%-26.7% for bare metal stent (BMS) and 9.8% for drug-eluting stents (DES). Overall major adverse cardiac events (MACE) rate was 11.7%. It was demonstrated that transradial PCI for CTO lesions is safe, minimizing vascular complications without increasing procedural time and contrast use.

Safety of transradial coronary intervention with early discharge in selected patients

Background and Objectives:Transradial percutaneous coronary intervention enables early ambulation and causes less complications at the puncture site. This study was performed in order to evaluate the safety of transradial coronary intervention with early discharge in selected patients. Materials and Method:Thirty patients were studied retrospectively. Twenty-five patients experienced transradial percutaneous coronary int- ervention with next morning discharge and 5 patients underwent transradial percutaneous coronary intervention on an outpatient basis. Each patient was checked for cardiovascular complications and other problems at the puncture site immediately following, 2 weeks after and 1 month after the procedure. Results:The study group consisted of 30 patients with a mean age of 60 years. The indications for intervention were unstable angina (63.3%, stable angina (20.0%, and restenosis at the 6-month follow-up after intervention. A total of 21 stents were implanted at 40 lesions. No major cardiovascular complication nor puncture site complication was reported at the 1 month follow-up. Conclusion:Early discharge at least 5 hours after intervention is safe for those with optimal angiographic results and no clinical problems. (Korean Circulation J 2001;31(10 :1013-1018

Transradial coronary intervention in Japanese patients.

The objectives of this study was to test the feasibility and safety of transradial coronary intervention (TRI) in Japanese patients. We compared the results of TRI in 1,791 lesions (1,360 patients) between November 1995 and December 1997 with those of transfemoral coronary intervention (TFI) in 966 lesions (793 patients) between April and October 1995. We also examined the radial artery pulse in 294 patients 1-2 weeks after TRI by palpation and Doppler examination. Arterial puncture, coronary artery cannulation, lesion, and patient success rates were similar in both groups. No significant difference was noted in the major complication rate. Local complications were significantly lower in the TRI group (0.3% vs. 3.3%, P < 0.001). Doppler studies of the radial artery were performed in 294 patients chosen at random. In the first 234 patients, the sheath was pulled out 3 hr after the procedure, and in the last 60 patients, immediately after the procedure; radial artery occlusion rates were 5% and 0%, respectively. In conclusion, TRI seems safe and feasible in Japanese patients.

Transradial coronary intervention in Japanese patients

The objectives of this study was to test the feasibility and safety of transradial coronary intervention (TRI) in Japanese patients. We compared the results of TRI in 1,791 lesions (1,360 patients) between November 1995 and December 1997 with those of transfemoral coronary intervention (TFI) in 966 lesions (793 patients) between April and October 1995. We also examined the radial artery pulse in 294 patients 1–2 weeks after TRI by palpation and Doppler examination. Arterial puncture, coronary artery cannulation, lesion, and patient success rates were similar in both groups. No significant difference was noted in the major complication rate. Local complications were significantly lower in the TRI group (0.3% vs. 3.3%, P < 0.001). Doppler studies of the radial artery were performed in 294 patients chosen at random. In the first 234 patients, the sheath was pulled out 3 hr after the procedure, and in the last 60 patients, immediately after the procedure; radial artery occlusion rates were 5% and 0%, respectively. In conclusion, TRI seems safe and feasible in Japanese patients. Cathet. Cardiovasc. Intervent. 46:37–41, 1999. © 1999 Wiley-Liss, Inc.