Transradial Approach Research Articles

Feasibility and Challenges of Transradial Approach in Neuroendovascular Therapy: A Retrospective Observational Study.

Transradial approach (TRA) is increasingly used as a viable alternative to the traditional transfemoral approach (TFA) in neuroendovascular therapy (NET) owing to its potential anatomical benefits and lower puncture-site complication rates. However, the real-world challenges of implementing TRA-NET have not been thoroughly studied, particularly those related to guide catheter (GC) placement. In this study, we aimed to explore the feasibility and challenges of TRA-NET, with a specific focus on GC placement. This retrospective observational study included patients who underwent NET at our institution between December 2019 and May 2022. Procedural success was defined as the successful placement of a GC in the target vessel. Cases in which a Simmons-shaped GC was used or the approach was changed to TFA were classified as difficult. Safety was assessed based on the rate of severe puncture-site complications requiring either blood transfusion or surgical intervention. Among the 310 patients who underwent NET during the study period, 222 (71.6%) with a median age of 74 years were selected for TRA-NET. The target vessel was in the left anterior circulation (LtAC) in 101 (45.5%) patients, and 8-F GCs were the most frequently used (40.1%). TRA-NET achieved a 95.0% success rate, with a switch to TFA required in 5.0% of the cases. Procedural challenges occurred in 42 (18.9%) patients, primarily in those with LtAC lesions. Specifically, a type III aortic arch (p <0.0001) and age ≥80 years (p = 0.01) were significantly associated with procedural difficulties. Radial artery evaluation was confirmed in 66 cases (29.7%), revealing one instance (1.5%) of radial artery occlusion. No severe puncture-site complications were observed. TRA-NET may provide substantial therapeutic benefits without significant limitations in device use. However, it may be challenging, particularly in older patients and those with a type III aortic arch with LtAC lesions. Consequently, careful selection of the approach route is imperative.

Utility of Flow Diverter Placement with a Transradial Approach

Utility of Flow Diverter Placement with a Transradial Approach

Comparison of Sheathless and Sheathed Guiding Catheters in Transradial Percutaneous Coronary Interventions: A Systematic Review and Meta‐Analysis

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs).Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834.Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross‐over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p &lt; 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all‐cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06).Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique’s long‐term outcomes and complications.

Dural Arteriovenous Fistula Treated with Transvenous Embolization via the Upper Limb Cutaneous Vein.

In recent years, the transradial artery approach has gained prominence and is increasingly employed in neurovascular angiography and therapy due to its safety, reduced complications, and minimal invasiveness. While various venous approaches, including the conventional transfemoral vein approach, exist for procedures such as transvenous embolization, recent reports have highlighted methods involving upper extremity cutaneous veins. However, the practicality and efficacy of these approaches remain unclear. This study presents our experience with three cases of dural arteriovenous fistulas, where transvenous embolization was performed via upper limb cutaneous veins. In all instances, the arteriovenous approach was successfully executed using a single upper extremity, leading to the successful completion of treatment. This technique demonstrates significant advantages, not only in terms of its minimal invasiveness but also due to its simplicity and safety. Anticipating broader acceptance in the future, this approach offers a promising avenue for further exploration in neurovascular interventions.

A case of flow diverter treatment by transradial approach of a left internal carotid artery aneurysm with an aberrant right subclavian artery

A case of flow diverter treatment by transradial approach of a left internal carotid artery aneurysm with an aberrant right subclavian artery

Ischemic Stroke Post-Transradial Chemoembolization

AbstractTransarterial chemoembolization is one of the approved locoregional treatment options for hepatocellular carcinoma. The procedure is safe; however, stroke may happen as one of the rarest complications. Our patient is a 68-year-old male who underwent transradial chemoembolization to treat hepatocellular carcinoma, who then developed ischemic stroke on postoperative day 1. The possible causes of stroke in our patient will be presented with review of the literature. Although rare, stroke post-chemoembolization can happen. The presence of intratumoral shunt or inadvertent injection of air bubbles in a coexisting right-to-left shun or the use of transradial approach can increase the risk of stroke.

Can Distal Radial Access Replace Conventional Radial Access for Coronary Catheterization? A Study Comparing Puncture Time, Attempts, Patient and Operator Comfort.

To compare distal (dTRA) and classical (cTRA) transradial approaches for coronary catheterization with respect to puncture attempts, puncture time, operator and patient comfort, and safety outcomes. In this prospective observational study, patients undergoing coronary catheterization for standard indications via dTRA or cTRA approaches from July 2019 to May 2020 were included. Clinicodemographic and laboratory characteristics were recorded. Puncture time, number of puncture attempts, operator and patient comfort on the visual analogue scale (VAS), and access site complications like hematoma and radial artery occlusion were recorded. Patients were analyzed in the same group as the initial puncture, even if there was a cross-over. Of the 130 patients (40.8% women), 50.8% and 49.2% belonged to dTRA and cTRA groups, respectively. dTRA group required more than one puncture attempt more frequently than cTRA group (30.3% vs. 15.6%; P =.047); consequently, puncture time was longer (60s vs. 50s; P =.031, respectively). However, puncture time was comparable if the puncture was successful in the first attempt (47.5s vs. 45s; P =.492). Patient comfort was comparable (7.2 ± 0.9 vs. 7.2 ± 1.2; P =.852), but operator comfort was more with cTRA approach (8.3 ± 1.6 vs. 8.8 ± 1.2; P =.048). Post-procedure, cTRA had more minor bleeding than dTRA approach. There was no major bleeding in either group. The occurrence of radial artery occlusion was comparable in both groups. Although dTRA needed more attempts for successful puncture, puncture time was comparable with cTRA when puncture was successful on the first attempt. Therefore, one attempt at dTRA puncture could be a reasonable approach in patients undergoing coronary catheterization.

Transradial Approach to Coronary Interventions in Central Nepal

Background The transradial approach (TRA) has gained popularity worldwide and it is the preferred access in many cardiac centers in Nepal. The aim of this study is to document single operator experience with TRA and its complications. Results A total of 214 patients were included with 114(53.27%) males and 100(46.73%) females. The mean age was (62.51 ± 12.47) years. The total transradial success rate was 88.78% for Coronary interventions. The crossover rate from radial to femoral access was 11.22%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop. Conclusions TRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.

Síndrome compartimental após ruptura espontânea de pseudoaneurisma da artéria radial esquerda

The transradial approach is indicated to reduce the risk of death, vascular complications, or bleeding. In patients with stable ischemic heart disease, the radial approach is recommended to reduce vascular complications and bleeding on access site. The complications are rare, and hematoma, perforation, and pseudoaneurysm (very rarely) of the radial artery may occur. This case report describes a rare case of left radial artery pseudoaneurysm associated with compartment syndrome in the left forearm after elective catheterization. The diagnosis was confirmed by Doppler ultrasonography, which showed a left radial artery pseudoaneurysm, measuring 2.1x1.5cm, with a 0.3-cm long/wide neck. Surgical treatment of pseudoaneurysm and compartment syndrome restored full limb function.

Safety, Efficacy, Feasibility of Trans Radial Approach Compared with Trans Femoral Approach in Patients Undergoing Coronary Catheterization

Background: Percutaneous Coronary Intervention has been done traditionally through Trans femoral route. Trans Radial route is coming up in the practice. We compared Trans Radial with Trans femoral accesses for ease of operability, time of procedure, complications, and failure rates through a cross sectional study. Objectives: To evaluate the safety, efficacy, feasibility and procedural variables in Trans radial approach compared with the Trans femoral Approach in patients undergoing coronary catheterization. Methods: A total of 180 patients with both chronic and acute coronary syndromes were enrolled in this study, 140cases with Radial 28 of whom were crossed to Femoral access(hence 112 Radials with 108 Right Radial and 4 Left Radial)and 68 cases with Femoral access. Results: Procedural time between Trans Radial and Trans femoral accesses were similar (17.39±10.33 vs19.68±16.62 minutes p 0.36) respectively while among Femoral crossover group was higher (33.50±20.30 minutes p0.01). Fluoroscopy time was (5.51±4.70 in Trans Radial Vs. 7.18 ±7.65 minutes in Trans femoral p 0.07) were similar in both groups. Post procedure access site complications seen in (9% in Trans Radial compared to 7.35% in Trans femoral P 0.048), Access site Hematoma being the most common one (6.25% in Trans Radial vs 4.4% in Trans femoral), Non-flow limiting dissections occurred in (0.89% in Trans Radial VS 1.4% Trans femoral), Radial artery perforation occurred in 1.78%, 1.4% of patients in Femoral group had Femoral artery perforation and had major bleeding. Conclusion: The overall local complications were lower in Trans femoral access, except for major bleeding which is still a big concern. Both vascular Access techniques should not be considered opposite or mutually exclusive, but rather provide the Interventionist a wide spectrum of the therapeutic options.

Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐Analysis

Background Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients. Although transfemoral arterial access remains the preferred method, it is associated with inherent limitations and potential complications. Consequently, exploring transradial artery access as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. There are limited data comparing the outcomes of the transradial with the transfemoral approach for CAS. This study aimed to systematically review and meta‐analyze the outcomes and complication rates between transradial and transfemoral access for CAS. Methods A systematic electronic search was conducted in 4 databases. Studies with randomized or nonrandomized designs, involving CAS by the transradial or transfemoral approach, were included. Outcomes of interest were stroke, transient ischemic attack, death, myocardial infarction, and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% CIs to assess the effect size. Results Six studies with a total of 6917 patients were included, of whom 602 (8.7%) underwent the transradial approach and 6315 (91.3%) the transfemoral approach. The meta‐analysis showed no significant difference in stroke occurrence between the transradial and transfemoral groups (transradial:1.7% versus transfemoral:1.9%; OR = 0.98 [95% CI, 0.49–1.96]; I 2 = 0%). Similarly, no significant difference was found in death (TR:1% versus transfemoral:0.9%; OR = 0.95 [95% CI, 0.38–2.37]; I 2 = 0%), myocardial infarction (transradial:0.2% versus transfemoral:0.3%; OR = 1.53 [95% CI, 0.20–11.61]; I 2 = 0%), transient ischemic attack (transradial:0.4% versus transfemoral:1%; OR = 0.46 [95% CI, 0.11–1.95]; I 2 = 0%), or access site complications (transradial:2.2% versus transfemoral:1%; OR = 0.97 [95% CI, 0.48–1.98]; I 2 = 0%). Conclusion No significant differences were observed in stroke, death, myocardial infarction, transient ischemic attack, or access site complications on comparing thetransradial and transfemoral approaches for CAS. The transradial approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings.

Early Experience With the Dual-Mode Radial-Access Catheter Armadillo in Neuroendovascular Procedures via the Radial Approach: A Multicenter Study of 71 Patients

BACKGROUND AND OBJECTIVES: The transradial approach is increasingly being adopted by neurointerventionalists after several studies showed its safety, efficacy, and patient satisfaction. However, the use of non–radial-specific devices for transradial procedures is a major barrier for transradial adoption. In this study, we aim to demonstrate the efficacy, technical feasibility, and safety of the Armadillo dual-mode guide catheter (Q'Apel Medical Inc.) as a radial-specific catheter in various neurovascular pathologies. METHODS: This is a multicenter retrospective study of 71 patients who underwent neurointerventional procedures via the transradial route using the Armadillo guide catheter between 2021 and 2023. RESULTS: Our study cohort comprised 71 patients, mostly females (n = 33, 63.5%) with a mean age of 59.1 ± 13.5 years. 13 (18.3%) patients underwent carotid artery stenting and angioplasty, 39 (54.9%) aneurysm treatment, 9 (12.7%) vascular malformation embolization, 5 (7.0%) tumor embolization, and 5 (7.0%) middle meningeal artery embolization for chronic subdural hematomas. The mean procedure time was 61.4 ± 33.5 min, mean fluoro time was 29.6 ± 14.4 min, and mean radiation exposure was 93.3 ± 56.3 Gy cm2. During the procedures, 70 (98.6%) target vessels were successfully catheterized. The rate of access site complications was 0%, and 1 (1.4%) patient required conversion to the transfemoral route. CONCLUSION: The use of the Armadillo catheter showed promising outcomes in terms of safety, effectiveness, and technical feasibility in various neuroendovascular procedures, demonstrating a high success rate and low morbidity rate.

Safety and Outcomes of Same-Day Discharge Versus Overnight Observation After Transradial Percutaneous Coronary Intervention: A Retrospective Cohort Study in a Tertiary Hospital in Philippines

INTRODUCTION: Since earlier days of percutaneous coronary intervention (PCI), there has been improvement in several aspects of PCI including use of transradial approach and third-generation drug-eluting stents. Despite data showing its safety, same-day discharge (SDD) PCI has not been widely practiced in our institution and country. At present, there are no published studies from the Philippines showing the safety and outcome of SDD PCI. OBJECTIVES: The primary objective of this study is to determine and compare the safety and outcomes of SDD versus overnight observation after PCI in The Medical City from 2018 to 2021. METHODS: This was a retrospective cohort study. The primary endpoint was to describe and compare the clinical profile of patients who underwent same-day versus overnight observation after PCI such as age, sex, comorbidities, indication for coronary angiogram, procedure time, total dye used, stent, and drug-eluting stent used. Incidence of major adverse cardiovascular event, mortality, readmission, and access site complications were also determined at 48 hours and 30 days after PCI. RESULTS: Ninety-three patients were included in the analysis. Reasons for undergoing PCI were a positive noninvasive stress test (45%), stable angina (40%), coronary artery disease (26%), and heart failure (20%). More single-vessel (60%) than multivessel (40%) PCIs were performed. The most frequently affected coronary artery was the LAD (82%), followed by right coronary artery (32%) and left circumflex artery (30%). Compared with patients who stayed longer after PCI, the SDD group had lower mean (±SD) body mass index (25.10 ± 3.12 vs 28.55 ± 4.95 kg/m2), less due to a positive noninvasive test (26% vs 51%), more who underwent a single-vessel PCI (78% vs 54%), lower median amount of injected dye (130 vs 188 mL), shorter median procedural time (74 vs 101.5 minutes), and greater use of sirolimus-eluting stent (22% vs 3%). No adverse outcome of interest was noted in any patient up to 30 days after hospital discharge. CONCLUSION: No adverse outcome was noted with SDD PCI. Larger, prospective, randomized comparative studies are needed to ascertain its safety before recommending SDD PCI routinely. KEYWORDS: left anterior descending artery, left circumflex artery, percutaneous coronary intervention, right coronary artery, same-day discharge

Feasibility and Safety of the Routine Distal Transradial Approach in the Anatomical Snuffbox for Coronary Procedures: The ANTARES Randomized Trial.

The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38-3.86, p = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, p < 0.05) and access-time [median: 140s (85-322) vs. 80s (58-127), p < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, p < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, p = 0.41) and mid-term (2.5% vs. 3%, p = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96-88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA.

Axillary Plexus Block for Anesthesia Management in Patients with Acute Compartment Syndrome after Primary Percutaneous Coronary Intervention (PCI) Transradial Approach: A Case Report

Background: Acute compartment syndrome is a rare complication of the percutaneous Coronary Intervention (PCI) transradial approach but it is very hand-threatening. Treatment for acute compartment syndrome is emergent fasciotomy of the affected compartments to reduce intracompartmental pressure. Axillary plexus block is an excellent choice of anesthesia technique for elbow, forearm, and hand surgery.&#x0D; Case presentation: An 80-year-old, 60 kg, 168 cm man was consulted to our department with a painful swelling on his right upper arm and hand that began three hours after a primary PCI procedure. Previously, the patient had a history of hypertension and diabetes mellitus. The supporting examination results were notable for anemia (Hemoglobin 7,5 g/dL), thrombocytopenia (78 x103/uL), elevated hemostasis function (International Normalized Ratio 1.43), and high blood sugar (360 mg/dL) from echocardiography results anteroseptal and lateral hypokinetic. Before we did block, the patient was given ketamine 10 mcg IV and fentanyl 25 mcg IV for sedation. Axillary plexus block, as a type of regional anesthesia under ultrasound guidance, is a reliable substitute for general anesthesia in high-risk patients, and we do it with a dose of 20 ml of solution (50 mg (10 ml) isobaric bupivacaine 0.5% + 200 mg lidocaine 2% diluted with 20 ml normal saline). During the surgery, the patient was hemodynamically stable. After the operation, the patient was readmitted to the intensive cardiac care unit (ICCU).&#x0D; Conclusion: Axillary plexus block can be an alternative to general anesthesia in patients who will undergo fasciotomy surgery after percutaneous coronary intervention transradial approach with stable hemodynamics during surgery and well-controlled pain after the surgery.

Sheathless radial approach in contemporary coronary rotational atherectomy: data from two high-volume centers

Aim: To analyze the feasibility and procedural outcome of percutaneous coronary intervention (PCI) using rotational atherectomy (RA), performed via transradial sheathless guiding catheter, as compared to a standard radial and femoral vascular approach. Methods: All consecutive patients undergoing RA at two high-volume PCI centers from May 2011 to May 2023 were included. Comparisons were made between the two transradial approaches and between the three types of vascular access. Results: Two hundred twenty-three patients were enrolled. Baseline characteristics were similar, with the exception of gender. We observed, in percentages, fewer cases of failure for sheathless than standard transradial attempts (7.5% vs. 11.5%, respectively), whereas all trans-femoral attempts were successful. Transfemoral procedures were longer and more frequently performed under mechanical circulatory support. There was no difference in procedural success between the three vascular approaches. A trend towards a higher rate of vascular and bleeding complications was found in the femoral group. Conclusion: Sheathless transradial vascular access is a viable option when performing RA during complex PCI procedures, tending to result in fewer failures than the standard transradial approach and reduced bleeding and vascular complications compared to the femoral method.

Transulnar artery approach in STEMI - Best alternative to radial?

Abstract Background Transulnar artery approach is a valuable alternative wrist access site for percutaneous coronary interventions. Currently published data about using transulnar approach (TUA) in the STEMI setting are missing. Due to its similarities with transradial approach (TRA), TUA in STEMI (ST segment elevation myocardial infarction) procedures can help in decreasing access site bleeding and vascular complications without sacrificing procedural success. Purpose To assess the success and safety of Transulnar access in STEMI. Materials and Methods In the period from March 2011 until December 2021, 8013 consecutive STEMI patients underwent primary PCI (percutaneous coronary intervention) in our center. All consecutive patients with transulnar approach (TUA) were included in a single center prospective registry of effectiveness and safety. The primary outcome was procedural success through ulnar access. We also examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TUA. Results In this period, 172 STEMI patients (2.1%) underwent PPCI through transulnar approach. Mean age of patients was 60 ± 12 years with 27% females. All procedures were successfully performed through right TUA. There were no STEMI TUA cases with crossover to Transfemoral approach. In 150 patients (87%) TUA was the primary choice of puncture due to no palpable radial artery from previous radial artery occlusion. In 22 patients (12.7%) the reason for crossover from primary TRA to TUA were complex RA anomalies. Type 3 and 4 EASY Score hematoma was present in 4 patients (2.3%). 7% of patients had over 1 access site puncture. UA spasm was registered in 1.7%. Mean procedural time was 32±23 min and fluoroscopy time was 8.5±9.2 min. Ulnar artery anomalies were registered in 1% of patients. There were no ulnar artery occlusions detected at discharge. There were no clinical or ischemic hand complications seen during clinical follow up. Conclusion Transulnar approach is safe and feasible alternative wrist access in the STEMI setting and can further decrease TFA crossover.

Distal radial approach using a transdermal nitroglycerin patch : double-blinded randomized trial

Abstract Background The distal radial approach (DRA) provides a lower risk of radial artery occlusion than the conventional transradial approach (TRA) and has recently been used worldwide as an alternative access route for coronary catheterization. However, the small diameter of the distal radial artery causes difficulty in puncture and leads to DRA failure. Purpose The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation. Methods A total of 92 patients with angina pectoris scheduled for elective coronary angiography via DRA randomly received (1:1) a transdermal nitroglycerin patch pre-integrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blinded fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture. Results The nitroglycerin group had larger distal radial artery diameter after patch application than the no-treatment group (3.21 ± 0.68 mm vs. 2.71 ± 0.52 mm, P&amp;lt;0.001), but not at baseline (2.64 ± 0.48 mm vs. 2.64 ± 0.45 mm, P = 0.965, Figure 1).The nitroglycerin group had a significantly higher success rate of palpation-guided DRA cannulation with the first puncture than the no-treatment group (58.7% vs. 23.9%; P = 0.001; odds ratio, 4.5; 95% confidence interval, 1.9–11.0, Figure 2). Fewer punctures were required for successful sheath insertion in the nitroglycerin group compared with the no-treatment group (1 [1–5] vs. 3 [2–6]; P=0.019). Procedure time from puncture to sheath insertion was shorter in the nitroglycerin group, but the difference was not significant (142 [112–287] seconds vs. 202 [142–411] seconds; P=0.058). The incidence of vasospasm, hypotension (systolic blood pressure &amp;lt; 90 mmHg) before and during CAG, and puncture site hematoma was similar in the two groups. No patients experienced distal radial arterial occlusion. Conclusions The use of a transdermal nitroglycerin patch was associated with an increase in the diameter of the distal radial artery, higher success rate of DRA cannulation with the palpation-guided first puncture. The transdermal nitroglycerin patch has a potential to be an effective pretreatment for DRA.Changes in distal radial artery diameterResults of primary outcome

Cardiovascular outcomes, mortality, and bleeding in patients with acute myocardial infarction and a history of cancer: a report from the multi-center, nationwide prospective database JAMIR

Abstract Background Limited data are available regarding the cardiovascular outcome including bleeding of patients with history of cancer who develop acute myocardial infarction (AMI). Purpose The purpose of this study was to analyze the characteristics and clinical outcomes of patients following AMI according to the history of cancer in in a contemporary cohort. Methods Consecutive patients with spontaneous onset of AMI were enrolled between December 2015 and May 2017 at 50 institutions in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. Patients were divided into 2 groups according to a history of cancer at admission for index AMI events. The outcomes of interest were all-cause death, major bleeding defined as BARC type 3 or 5, and composite ischemic events defined as cardiovascular death, myocardial infarction and ischemic stroke. These events were analyzed by the log-rank test, and Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a Cox proportional hazards model with adjustment for covariates such as age, sex, body weight, ST-elevation MI, use of anticoagulants, history of cerebrovascular disease, trans-radial approach procedure, Killip class ≥2, estimated glomerular filtration rate, and history of previous MI or percutaneous coronary intervention. Results A total of 3,411 AMI patients were enrolled, and followed for a median of 358 days. Among those, 292 patients (8.6%) had a history of cancer and they were older and had more comorbidities than those without (mean age [standard deviation], 76.0 [9.9] vs 67.4 [13.3]; P&amp;lt;0.001). They had a similar risk of composite ischemic events (adjusted HR [adjHR] 1.18 [95% CI 0.80–1.75], P=0.39), and major bleeding (adjHR 1.13 [95% CI 0.70–1.83], P=0.61) compared with those without, whereas were at higher risk for all-cause mortality (adjHR 1.64 [95% CI 1.16–2.32], P=0.005; Figure 1). While no between-group difference in cardiovascular death was observed, non-cardiovascular death and death due to cancer were higher in the cancer group than in the no-cancer group (adjHR 1.38 [95% CI 0.85–2.24], P=0.19; adjHR 2.05 [95% CI 1.24–3.39], P=0.005; adjHR 18.16 [95% CI 6.74–48.97], P&amp;lt;0.001, respectively). When further stratified by age, there was neither the difference in cardiovascular events nor bleeding events by the presence or absence of a history of cancer, whereas the difference in all-cause mortality became pronounced in the group aged&amp;lt;75 years but not in the group aged&amp;gt;75 years (adjHR 3.32 [1.88–5.85] and 1.26 [0.81–1.96], respectively; Figures 1 and 2). There was a significant interaction between caner and age (P for interaction=0.008). Conclusion The real-world multi-center database JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged&amp;lt;75 years. These results might suggest the need for a multidisciplinary approach to improve the prognosis of younger AMI patients with a history of cancer.Figure 1Figure 2

Transradial versus transfemoral approach in cerebral angiography: A meta-analysis.

Cerebral angiography has two common access sites: Transradial approach and transfemoral approach. However, there's no definitive answer to which one is superior. Compare transradial approach and transfemoral approach for a cerebral angiography procedure. A systematic review of the literature of studies reporting both transradial approach and transfemoral approach results was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Cochrane Library, and Embase were queried. The meta-analysis examined 18 studies comprising 9388 patients undergoing cerebral angiography. Among the patients, 4598 underwent transradial approach (48.9%) and 4790 underwent transfemoral approach (51.1%). Our results revealed no statistical differences between the approaches regarding procedure success, crossover to transfemoral approach, procedure and fluoroscopy time between both approaches in cerebral angiography. Total, major, and minor complications comparisons were more favorable to transradial approach for this procedure. These findings suggest, despite the ultimate decision regarding the choice of access method might be influenced by the physician's experience and personal preference, the data distinctly lean toward transradial approach as the preferable option for cerebral angiography. The advantages of transradial approach, highlighted by its lower complication rates, especially major complications, suggest that its adoption could contribute to enhanced patient safety and procedural outcomes.