Transradial Angiography Research Articles

SCAI expert consensus statement update on best practices for transradial angiography and intervention.

Transradial angiography and intervention continues to become increasingly common as an access site for coronary procedures. Since the first "Best Practices" paper in 2013, ongoing trials have shed further light onto the safest and most efficient methods to perform these procedures. Specifically, this document comments on the use of ultrasound to facilitate radial access, the role of ulnar artery access, the utility of non-invasive testing of collateral flow, strategies to prevent radial artery occlusion, radial access for primary PCI and topics that require further study.

Initial Experience with Transradial Intraoperative Angiography in Aneurysm Clipping: Technique, Feasibility, and Case Series

The transradial approach has slowly been gaining momentum in neuroendovascular procedures. We sought to assess its feasibility and safety and present a case series of transradial intraoperative angiography (IOA) during microsurgical clip ligation of intracranial aneurysms. The setup and technique for transradial intraoperative angiography are described. Data on 10 consecutive patients undergoing IOA through the radial artery are presented. All target vessels were successfully catheterized transradially, and conversion to the transfemoral access was not required in any of the cases. There was no access-site complication, such as hand ischemia, hematoma, or radial artery spasm. There were also no thromboembolic events causing a stroke. The average time for the IOA was 9.3 minutes. Our initial experience shows the transradial approach for IOA in clip ligation of aneurysms to be feasible and safe, with potential advantages over transfemoral IOA.

P4705Transpedal access for below-the-knee lesions in critical limb ischemia

Abstract Background Traditional access for the treatment of below-the-knee (BTK) lesions is the femoral approach, but in failed anterograde cases transpedal access can be utilized. The aim of the study was to evaluate the safety and technical and clinical success of endovascular BTK artery revascularization by a primarly retrograde transpedal access. Methods The clinical and angiographic data of 115 consecutive patients treated via transpedal access with symptomatic BTK stenosis were evaluated two cardiovascular centers (Europe and USA). We have selected patients with good distal run-off and non-infected distal puncture zone. The distal pedal artery was punctured by ultrasound guidance, and the procedural guidance was done by transpedal (TPA) or transradial angiography (TRA). Distal pressure at the end of the pedal sheath was also measured before and after the intervention. The primary endpoint was a composite of procedural success, major adverse events, and rate of access site complications. Secondary endpoints were: angiographic result of BTK intervention, fluoroscopy time, X-ray dose, procedure length, cross over rate to another puncture site and duration of hospitalization. Results The indication of the intervention was critical limb ischemia in all patients. Overall technical success was achieved in 99.1% of the patients at least in one BTK artery. The distal puncture was successful in 114/115 patients 99.1% of the patients and the access site was anterior tibial artery in 96 patients (83.55), posterior tibial artery in 15 patients (13%) and peroneal artery in 4 patients (3.5%). Pedal to femoral access site cross over was 0.5%. Control angiography was done in 73 patients (63.5%) from radial and in 42 patients (36.5%) from transpedal access. The average contrast, procedure and fluoroscopy time was 109.9 [97–123]vs 31.4 [27–35]ml (p<0.001), 43.2±22.3 vs 47.8±25.5 min and 581±448.7 vs 788±605 sec in the TR and TP group.The average systolic transpedal pressure has been increased from 100.1 mmHg ±44 to 131±36.4 mmHg after the procedure. Major adverse event at one month was detected in six patients (5.2%).Radial and pedal artery access site complications were encountered by ultrasound in 3/73 (4.1%) and 3/115 patients (2.6%) during follow up. Conclusion Below-the-knee artery angioplasty can be safely and effectively performed using radial and transpedal access in selective patient population.

TCT-799 A Pilot Study of Accelerated Radial Artery Hemostasis Following Percutaneous Transradial Coronary Angiography/Intervention, Utilizing a Novel Topical Hemostatic Agent in Conjunction With Surface Compression

Transradial angiography (TRA) is safe and efficacious, but hemostasis time remains variable and is often longer than necessary, contributing to radial artery occlusion (RAO), which occurs in 1% to 10% of patients. Hydrophobically modified (hm) chitosan is a novel formulation of an established

Placement of the Woven EndoBridge (WEB) device via distal transradial access in the anatomical snuffbox: A technical note

The distal transradial access in the anatomical snuffbox for neurovascular procedures is a modification of the radial access with an improved safety profile and patient comfort compared to the conventional transradial access. However, its use has been limited to diagnostic cerebral angiography, but not aneurysm treatment.We present the first case of a 53-year-old female whose work-up for headaches showed an anterior communicating artery aneurysm. The patient underwent distal transradial cerebral angiography and subsequent placement of a Woven EndoBridge (WEB) device for treatment of the aneurysm through the same access site. The procedure was uneventful and the patient was discharged home neurologically intact. Her hand remained warm, well-perfused, and with no visible or palpable hematoma.Our report illustrates the feasibility of the distal TRA for the treatment of cerebral aneurysms using the WEB device. Further studies are necessary to confirm the additional benefits of the distal TRA over TRA for neurovascular access.

Intraoperative transradial angiography augments safe hysterectomy for uterine fibroids in the setting of ambiguous arterial anatomy: a case report

BackgroundTransfemoral access is the traditional gold standard for uterine artery angiography; however, transradial access is gaining in popularity because of its decreased complication profile and patient preference. We present a case of a patient who underwent successful total abdominal hysterectomy for symptomatic uterine fibroids with ambiguous pelvic vasculature that would have been otherwise aborted if it were not for intraoperative transradial access angiography.Case presentationA 52-year-old Caucasian woman presented to her gynecologist for an elective total abdominal hysterectomy and bilateral salpingo-oophorectomy. During preoperative imaging, a 15-cm mass consistent with a uterine fibroid was identified, and the patient’s gynecologist decided to treat her with surgical resection, given the fibroid’s size. The procedure was halted upon discovery of a complicated vascular plexus at the fundus of the uterus, and an intraoperative vascular consult was requested. The vascular operator used a transradial access to perform pelvic angiography in real time to identify the complicated pelvic vasculature, which allowed the gynecologist to surgically resect the uterine fibroid. The patient was discharged on postoperative day 4 without any complications.ConclusionsIntraoperative imaging is a useful technique for the identification of complicated anatomical structures during surgical procedures. The successful outcome of this case demonstrates an additional unique benefit of transradial access and highlights an opportunity for interdisciplinary collaboration for management of complicated surgical interventions.

Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography

The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5±3.4min, the average operation duration was 47±3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3±8.1mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2hr after operation; this patient was re-pressurized and re-timed. This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.

Ultrasonic Assessment of Subclinical Radial Artery Stenosis After Transradial Angiography

Ultrasonic Assessment of Subclinical Radial Artery Stenosis After Transradial Angiography

Abstract 17406: Early Experience With Ultrasound Guided Distal Trans-Radial Access in the Anatomical Snuffbox in Coronary Angiography and Intervention

Early experience with ultrasound guided distal trans-radial access in the anatomical snuffbox in coronary angiography and intervention. Objective: We aimed to demonstrate the feasibility and safety of the ultrasound guided distal trans-radial coronary angiography and intervention. Methods: Patients assigned to one operator program underwent diagnostic or procedural intervention through distal trans-radial approach in the anatomical snuffbox between January 2018 and May 2018. All of patients had palpable artery in their distal radial artery. The operator did the coronary procedure via distal radial access at anatomical snuffbox. When the pulse was weak or the target artery was very small, the operator punctured under ultrasound guidance (V-scan with dual probe, GE heathcare, USA) Results: 56 patients were enrolled. Mean age of patients was 65.1 years old and 68% were male. About 70% of patients were presented with stable angina feature. In diagnostic procedure, 4F (3, 5.6%) or 5F (29, 54.7%) sheath was used and we did coronary intervention via 6F (21, 39.6%) Sheath. Ultrasound guided puncture was done for 33 patients (58.9%). Overall Success rate of distal trans-radial angiography and intervention was 94.6% (3 failed cases). Success rate of ultrasound guided procedure was 97% (only 1 failed case). Left distal radial puncture was done for 18 patients (33.9%). 16% of patients had chronic kidney disease, especially end stage renal disease (11%) to preserve radial artery which was potential candidate of arteriovenous fistulae for dialysis. There was no BARC type 2-5 bleeding in hospital stay and follow up at out-patient clinic. Conclusion: Ultra sound guided distal radial approach is feasible and safe as a good alternative technique for coronary angiography and interventions.

CORONARY CATHETERIZATION

Introduction: In recent years the trans-radial approach has been increasinglyemployed as an alternative approach to percutaneous coronary intervention. Loss of radial pulsemay lead to ischemic symptoms like pain in hand, claudication etc. There is a lack of local dataregarding complication associated with trans-radial coronary catheterization. Therefore, thereis need for local study to find out the frequency of complications associated with trans-radialapproach. Objectives: To determine the frequency of loss of radial pulse in patients undergoingtrans-radial coronary catheterization. Design: Cross sectional study. Setting: Department ofCardiology, Jinnah Hospital, Lahore. Period: From 3rd June 2014 to 2nd December 2014.Methodology: All 325 cases fulfilling the inclusion/exclusion criteria undergoing coronarycatheterization were included in the study. Results: A total of 325 patients, both male and femalewith positive Allens test, undergoing Trans-radial angiography for intervention were included.Loss of radial pulse was evaluated clinically at four weeks follow up.In our sampled population,mean age was 57.01 ± 6.8 years and 240 patients (73.8%) were male while 85 patients (26.2%)were female. Only 14 patients (4.3%) out of 325 had loss of radial artery pulse while remaining311 patients (95.7%) didn’t have loss of radial artery pulse. There was found no effect of genderon outcome i.e. loss of radial pulse but older age made a person prone to loss of radial pulse.Conclusion: It is concluded that the frequency (percentage) of loss of radial pulse is quite low(4.3%) in our patients undergoing trans-radial coronary catheterization.

FREQUENCY OF LOSS OF RADIAL PULSE IN PATIENTS UNDERGOING TRANSRADIAL CORONARY CATHETERIZATION

Introduction: In recent years the trans-radial approach has been increasinglyemployed as an alternative approach to percutaneous coronary intervention. Loss of radial pulsemay lead to ischemic symptoms like pain in hand, claudication etc. There is a lack of local dataregarding complication associated with trans-radial coronary catheterization. Therefore, thereis need for local study to find out the frequency of complications associated with trans-radialapproach. Objectives: To determine the frequency of loss of radial pulse in patients undergoingtrans-radial coronary catheterization. Design: Cross sectional study. Setting: Department ofCardiology, Jinnah Hospital, Lahore. Period: From 3rd June 2014 to 2nd December 2014.Methodology: All 325 cases fulfilling the inclusion/exclusion criteria undergoing coronarycatheterization were included in the study. Results: A total of 325 patients, both male and femalewith positive Allens test, undergoing Trans-radial angiography for intervention were included.Loss of radial pulse was evaluated clinically at four weeks follow up.In our sampled population,mean age was 57.01 ± 6.8 years and 240 patients (73.8%) were male while 85 patients (26.2%)were female. Only 14 patients (4.3%) out of 325 had loss of radial artery pulse while remaining311 patients (95.7%) didn’t have loss of radial artery pulse. There was found no effect of genderon outcome i.e. loss of radial pulse but older age made a person prone to loss of radial pulse.Conclusion: It is concluded that the frequency (percentage) of loss of radial pulse is quite low(4.3%) in our patients undergoing trans-radial coronary catheterization.

Transradial cerebral angiography: techniques and outcomes

BackgroundDespite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based...

Clinical Characteristics of Patients With Stable Coronary Artery Disease Undergoing Angiography by Trans-Femoral Versus Trans-Radial Approach

Background: The benefits associated with trans-radial coronary angiography (TR-CA) and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes has not been replicated in those with stable coronary artery disease (CAD). Furthermore, TR-CA may cause structural injury to the radial artery, making it an unattractive conduit for bypass graft surgery. This study aimed to describe clinical characteristics of patients with stable CAD undergoing trans-radial vs trans-femoral angiography, and to identify variables likely to result in coronary artery bypass surgery.

Complications Following Transradial Cerebral Angiography : An Ultrasound Follow-Up Study.

ObjectiveThe feasibility and usefulness of transradial catheterization for coronary and neuro-intervention are well known. However, the anatomical change in the catheterized radial artery (RA) is not well understood. Herein, we present the results of ultrasonographic observation of the RA after routine transradial cerebral angiography (TRCA). MethodsPatients who underwent routine TRCA with pre- and post-procedure Doppler ultrasonography (DUS) of the catheterized RA were enrolled. We then recorded and retrospectively reviewed the diameter and any complicated features of the RA observed on DUS, and the factors associated with the diameter and complications were analyzed. ResultsA total of 223 TRCAs across 181 patients were enrolled in the current study. The mean RA diameter was 2.48 mm and was positively correlated with male gender (p<0.001) and hypertension (p<0.002). The median change in diameter after TRCA was less than 0.1 mm (range, -1.3 to 1.2 mm) and 90% of changes were between -0.8 and +0.7 mm. Across 228 procedures, there were 12 cases (5.3%) of intimal hyperplasia and 22 cases (9.6%) of asymptomatic local vascular complications found on DUS. Patients with abnormal findings on the first procedure had a smaller pre-procedural RA diameter than that of patients without findings (2.26 vs. 2.53 mm, p=0.0028). There was no significant difference in the incidence of abnormal findings for the first versus subsequent procedures (p=0.68). ConclusionDUS identified the pre- and post-procedural diameter and local complications of RA. Routine TRCA seems to be acceptable with regard to identifying local complications and changes in RA diameter.

‘New Developed Femoral-S Carotid Catheter’ is Very Effective and Safe in Carotid Angiography: A Retrospective Study

Objective: There is no special catheter used for carotid angiography in the market. We studied the efficacy feasibility and safety of Femoral S carotid catheter (made by shaping existing catheters) in this study. Methods: 1169 patients undergoing transfemoral or transradial carotid angiography between the years 2015 and 2017 were evaluated. The 156 patients found that are underwent carotid angiography with Femoral S catheter. Results: The Baseline characteristics of the patients were record. The total time of the procedure with the new catheter was found 7.2 ± 1.3 min and the amount of opaque media used was 50.20 ± 15.60 ml. Selective imaging success was high 95%. Minor Complication (local hematoma, leg pain, dizziness, headache, hypotension, allergic reaction of the contrast media) development was found 3.8%. Permanent damage, morbidity and/or mortality were not seen in patients. Discussion: The right judkins catheter is usually preferred in the carotid angiography performed with the femoral route. The newly developed catheter does not stick to the aortic wall because the tip is in the “S” shape. Therefore, the processing time is shorter and the imaging performance is better than multipurpose catheter. Conclusion: Carotid angiography with the newly developed Femoral S carotid catheter seems easier and safer. Performing of Carotid angiography may help to reduce stroke frequency at the time of coronary angiography in patients with coronary artery disease.

Nursing care of transradial angiography and intervention in a tertiary hospital in Shanghai: a best practice implementation project.

Coronary heart disease is common in the general population and is estimated to cause as many deaths worldwide as cancer. Percutaneous coronary angiography and intervention is the most common method in the diagnosis and treatment of coronary heart disease. To achieve best practice in the nursing care of transradial angiography and intervention, there is an urgent need for clinical knowledge. This aim of this project was to improve clinical nursing care for transradial angiography and intervention in Zhongshan Hospital, Shanghai. Seven criteria identified from evidence by the Joanna Briggs Institute were audited in the coronary care unit of Zhongshan Hospital, Shanghai. Twenty-three nurses and 80 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over six months. This best practice implementation project improved the rates of written discharge instructions and radial artery patency assessment at the first post-procedure from 0% to 100%. Implementation rates for pre-procedural checklist as well as the radial artery patency assessment before discharge were 100% at baseline. Pre-procedural checklists including adequate criteria reached 78%, up from 0%. The implementation rate for regular monitoring of vital signs recorded for the first two hours post-procedure reached 22% from 0%. The implementation rate for details of discharge instructions, including procedure review, limitation of physical activity, general physical status, comorbidities, medication reconciliation and follow-up appointment improved from 36.6% to 100%. Barriers to implementation were identified as: (1) the structured pre-procedural checklist not being ready, (2) nurses lacking knowledge regarding discharge education for transradial angiography and intervention, (3) heavy clinical workload and lack of time, and (4) nurses lacking awareness and enthusiasm for implementing discharge education. This project achieved significant improvements in establishing evidence-based practice in nursing care of transradial angiography and intervention for patients. Strategies for sustaining best practice should continue to be developed in the future.

Radial artery pseudoaneurysms after transradial cardiac catheterisation.

Although uncommon, radial artery access site complications are likely to become more frequent with the increased adoption of transradial cardiac catheterisation. There is a lack of data regarding the incidence and clinical features of radial artery pseudoaneuryms. We aimed to describe the incidence, clinical features and management of radial artery pseudoaneurysms in a high-volume transradial cardiac catheterisation centre. We performed a search of the Vancouver Island Health Authority medical imaging database from 1st Jan 2008 to April 2012 looking for all radial and femoral artery pseudoaneuryms occurring after cardiac catheterisation. Hospital charts were reviewed to determine patient and procedural characteristics as well as management and outcome. There were a total of 14,968 coronary procedures performed over the four year search period, of which 13,216 (88%) were trans-radial. The incidence of radial artery pseudoaneurysm after cardiac catheterisation was 0.08%, and did not differ between transradial diagnostic angiography and PCI (0.07% vs 0.08%; P = 0.90). In contrast, the incidence of femoral artery pseudoaneurysm was higher, at 1.4% (P < 0.0001). Patients with radial pseudoaneurysms were generally elderly, with a median age of 77 years, and there were no gender differences. Only one patient had received a glycoprotein IIb/IIIa inhibitor, whilst two received warfarin post-procedure. The majority of cases (80%) were treated with surgical repair. We have demonstrated that radial artery pseudoaneuryms are a rare but important complication of transradial cardiac catheterisation, with patients generally requiring surgical repair. Most patients were elderly, but surprisingly only a minority were anti-coagulated with warfarin.

Radial artery anomalies in the Macedonian population during transradial angiography procedures

Objective: To assess the incidence of arterial anomalies of the radial artery in the Macedonian population registered during transradial access (TRA) angiography procedures in a large series of patients. Background: Transradial angiography (TRA) is now the recommended access for percutaneous coronary intervention, but technically is a more challenging approach for angiography procedures mostly due to the anatomic anomalies on the radial artery, which may influence the success rate of transradial angiographic procedures. Methods: All consecutive 19292 patients from our Center, in the period from March 2011 until December 2014 were examined. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type and incidence of vascular anatomy variants and access site complications were analyzed. Results: Anatomical variants were present in 1625 (8.8%) patients. The most frequent was high-bifurcating radial artery origin from the axillary and brachial arteries in 1017 (5.5%) patients, 227 (1.2%) had extreme radial artery tortuosity, 176 (0.95%) had a full radial loop, 32 (0.17%) with hypoplastic radial artery and 173 (0.9%) had tortuous brachial, subclavian and axillary arteries. Radial artery spasm was very common in patients with present radial artery anomalies. Conclusion: Radial artery anomalies are very common in the general population. Knowing the anatomy of the radial artery helps the interventional cardiologist in successfully planning and performing this procedure. Radial artery angiography is strongly encouraged in every patient before the begining of the transradial angiography procedures.

Abstract 15311: Anomaly and Narrowing of Radial Artery and its Impact to the Transradial Angiography and Intervention

[Background] Increasing number of transradial coronary procedures are now performed because of the advantage of reduced access site complications. However, transradial approach sometimes ends in failure or vascular complication due to arterial anomaly or stenosis. [Objective] The objective of this study was to clarify the types and frequency of radial or brachial arterial anomaly and narrowing in patients who undergone cardiac catheterization. [Methods] Total of 1135 consecutive patients who underwent transradial cardiac angiography or intervention from Jan. 2013 to May 2015 were subjected. In all cases, angiography of radial and brachial arteries was performed through the inserted sheath. After removing the duplicating cases, we analyzed 826 arms of 786 patients. [Results] Of total 826 angiographies, 622 were identified as normal. There were 20 (2.4%) cases of 'high-bifurcation' in which radial artery originates proximal of the intercondylar line of the humerus. 'Radial loop' with a full 360 degree loop of the radial artery and accompanied by the recurrent artery which originates at the loop was identified in 9 (1.1%) cases. 'Radial simple loop' and 'brachial simple loop' with a full 360 degree loop without recurrent artery were observed in 5 (0.6%) and 6 (0.7%) cases, respectively. 'Radial or brachial tortuosity' with a bend of more than 90 degree existed in 64 (7.7%) and 45 (5.4%) cases, and 'narrow radial or brachial' with the vessel diameter &lt;2.0mm in 113 (13.7%) and 5 (0.6%) cases (some cases were duplicated). In high bifurcation, loop, or tortuosity cases, narrowing of the vessels of catheter route also coexisted in 20-89% cases. Cardiac catheterization ended in failure in 7 (1.1%) of normal radial and brachial artery cases, and in 31 (11.6%) cases of radial or brachial arterial abnormalities (p&lt;0.0001). Among the 31 failure cases with radial or brachial artery abnormalities, the cause of the failure was narrowing of a catheter route in 24 (77%) cases, and 1 case with both radial tortuosity and narrowing ended in radial artery perforation. [Conclusion] Radial artery anomaly and narrowing are not infrequent and often coexist, and lead to procedure failure or even vascular complications, indicating a need of confirmation of vascular anatomy by angiography.

Evaluation of Previously Cannulated Radial Arteries as Patent Coronary Artery Bypass Conduits.

In coronary artery bypass grafting, good-quality conduits are needed to maximize the potential for long-term patency. Revascularization has traditionally been achieved with use of the saphenous vein and the internal thoracic arteries. In recent years, total arterial revascularization with use of the radial arteries has been promoted. Meanwhile, use of the transradial approach for coronary angiography has also increased. The long-term effects of previous cannulation in radial artery bypass grafts are not known. Therefore, we used multidetector computed tomographic angiography to investigate radial-artery graft patency in a small series of patients who had undergone transradial angiography. We found a high patency rate, and we discuss those findings here.