Transradial Approach For Coronary Intervention Research Articles

Left Distal Transradial Approach for Coronary Intervention: Insights from Early Clinical Experience and Future Directions.

Left distal transradial approach is a novel technique for coronary intervention. This technique is convenient for specialists to operate and welcomed for right-handed patients. The anatomical snuffbox and the first intermetacarpal are two available puncture sites on the basis of hand anatomy. In technical aspects, main differences between left distal transradial approach and conventional transradial approach are patient's special position, puncture procedure, sheath choice, and hemostasis methods. According to the preliminary data, this technique is feasible and safe and it has low rate of complications including radial artery occlusion in forearm. Left distal transradial approach is a quite promising strategy of coronary intervention and deserves further exploration. In this review article, we describe the main technical characteristics and the results obtained from early clinical experiences. We also discuss the main challenges and future perspectives on this novel technique.

RANDOMIZED STUDY COMPARING STRATEGIES TO COMBAT RADIAL ARTERY SPASM: THE COMBAT SPASM TRIAL

Transradial approach for coronary interventions is associated with fewer vascular complications and improved outcomes especially in the acute patient setting. However, radial artery spasm (RAS) is a major limitation and the main cause of access site crossover. There is still controversy about the

Use of 5 F vs. 6 F guide catheter by left transradial approach for coronary intervention in diabetic population

Use of 5 F vs. 6 F guide catheter by left transradial approach for coronary intervention in diabetic population

TCT-290 Trans-radial approach for coronary intervention in female patients with Acute Coronary Syndrome

TCT-290 Trans-radial approach for coronary intervention in female patients with Acute Coronary Syndrome

Multi-vessel percutaneous coronary intervention in a patient with a type B aortic dissection-transradial or transfemoral?

Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure- related complications in this high-risk group of patients.

Transradial Approach for Coronary Intervention: 25 Years for 25 Centimeters

The first series of transradial coronary angiograms was carried out by Lucien Campeau and published in 1989. The devices available at that time made the technique difficult to perform. Four years later, when stenting started being widely used with a significant rate of local complications induced by Coumadin treatment, F. Kiemeneij proposed the radial approach as a good alternative to the femoral approach to reduce the rate of local complications. Since then, the use of the radial approach has been increasing, though it remains limited. The first reason for this lies in the significant learning period that is all the longer as a low percentage of patients are treated via this approach. This is why we think it is preferable to perform at least 25% of all procedures, and especially coronary angiograms, through this approach before setting up a radial program. Patients with contraindications to the femoral approach (anticoagulation or GP IIb/IIIa inhibitors, obesity, aneurysm of the abdominal aorta, or vessel disease of the lower limbs, etc.) should be selected. The second reason is the small diameter of the radial artery that can generate a number of problems when large diameter guiding catheters are used (7Fr or 8Fr). However, the reduction in guiding‐catheter size, and the increasing use of 6Fr catheters should solve this problem. In our center, the femoral approach is usually selected when 7Fr or 8Fr catheters are used. It is to be noted that the radial approach is now widely used in some interventional cardiology centers where the learning period has been completed. With operator experience, puncture failure is extremely rare and the technical failure rate is around 1%, mainly due to the anatomic variations of the radial artery (antebrachial and humeral loops). Apart from the difficulties associated with the learning curve, the radial approach has few limitations. The procedure and x‐ray exposure times are slightly longer for coronary angiography but not for angioplasty. The risk of radial occlusion ranges from 2% to 5%, however, radial occlusion is asymptomatic in patients with a normal Allen's test. Conversely, the radial approach has many advantages. Patient comfort is significantly improved due to the ease of radial compression, ambulation is almost immediate, and the rate of local complications is almost nil. Same day discharge following coronary angiography and angioplasty can be considered. Finally, with the increasing use of GP IIb/IIIa inhibitors, sometimes in combination with thrombolysis in the treatment of myocardial infarction, the radial approach could become the preferred approach in this setting.

Trans-radial Coronary Stenting in two hospital : Comparison with Trans-femoral Approach

Background and Objectives:The transradial approach for coronary intervention has a lower incidence of access site complications and can increase patient comfort after percutaneus tansluminal coronary angioplasty (PTCA). The purpose of this study is to compare procedural success and complication rates of percutaneous transradial coronary stenting which was performed by four operators in two hospitals with those using transfemoral approach. Materials and Methods:From September 1998 to July 1999, one hundred seventy five consecutive patients (201 lesions) treated with coronary stent implantation were enrolled for this study:84 patients underwent transradial coronary stenting (Radial Group), and 91 patients transfemoral coronary stenting (Femoral Group). Results:Seven patients who failed coronary cannulation via radial artery were crossed over to the Femoral Group. The measurements of the radial artery were not done. Patient demographics were similar in both groups. Procedural success was similar in both group (95.2% in Radial Group vs. 97.8% in Femoral Group, p=NS). All transradial coronary stenting were possible using conventional guiding catheters which are used in transfemoral intervention. Local vascular complication rates showed a trend toward a reduction in the Radial Group (2.4% vs. 8.8%, p=0.06). Conclusion:This study showed the similarity in the safety and efficacy of transradial coronary stenting compared to those of transfemoral approach. (Korean Circulation J 2000;30(7):827-832)