Transradial Catheterization Research Articles

Shared Decision-Making in Femoral Versus Radial Cardiac Catheterization

Shared decision-making is a strategy to assist with patient involvement in medical decisions. One of its pillars is patient knowledge and understanding of the risks and benefits associated with specific procedures. We studied patient knowledge about transradial (TRA) and transfemoral (TFA) cardiac catheterization. A prospective study was conducted in 100 patients hospitalized following diagnostic and therapeutic cardiac catheterization-TRA in 71% of patients and remaining TFA. All patients were presented a standard balanced informed consent outlining risks and benefits. Following catheterization, patients were verbally administered an 11-item open-ended questionnaire to assess knowledge of cardiac catheterization and the associated risks and benefits. A patient knowledge index (PKI) was developed with 1 point given for: identifying the procedure; correctly describing the procedure; identifying at least 1 risk of TRA; and/or TFA; and at least 1 benefit of TRA; and/or TFA. Maximum PKI score was 6. The mean PKI score was 2.6 ± 1.1. A PKI score ≥4 was observed in 21% of patients with only 1 patient obtaining the maximum 6 points. Over 80% of patients were unable to recall procedure risks provided at the time of informed consent. The majority of patients were unable to discriminate between TRA and TFA risks and benefits, PKI 2.52 versus 2.60, respectively (p = 0.718). On multivariate analysis, higher education levels were correlated with increased PKI scores (odds ratio = 0.65, p = 0.014) whereas black race was associated with lower PKI scores (odds ratio = -0.48, p = 0.045). In conclusion, patient retention of information from the informed consent was low. The majority of patients had no preference or deferred to their physician's expertise when deciding TRA compared with TFA. This study identifies challenges with implementing shared decision-making and the need for improved patient education and involvement regarding cardiac catheterization.

Successful Treatment of Pseudoaneurysm Following Left Distal Transradial Cardiac Catheterization With Compression Device

Distal transradial artery access has emerged as a promising new method of access for coronary and endovascular procedures. With the increasing use of distal transradial artery access, operators will need to gain experience in the management of complications in the anatomical snuffbox. We review the rationale behind distal transradial access and summarize rate of vascular complications, based on the review of the literature. We then report a case of pseudoaneurysm in the distal left radial artery occurring 20 hours after cardiac catheterization likely precipitated by intravenous heparin and dual antiplatelet therapy with aspirin and prasugrel received during a second procedure. A modified compression technique with the TR band® (Terumo Medical Corporation, Tokyo, Japan) was used in which the rigid, plastic insert was removed prior to application to facilitate improved apposition of the band on the dorsum of the hand, and waveforms from continuous pulse oximetry were used to guide “patent compression.” Thrombosis of the pseudoaneurysm was achieved in 12 hours, and no further intervention was required.

Wygięcie cewnika typu „pętli kobry” w obrębie odejścia tętnicy bezimiennej od łuku aorty w trakcie cewnikowania z dostępu przez tętnicę promieniową — fluoroskopowe wskaźniki tętnicy błądzącej

The retroesophageal right subclavian artery (ROSRA; arteria lusoria) is one of the anatomical abnormalities encountered at innominate-arch junction during transradial catheterization by right route. Here, we report a case of a 49-year old female who presented with chronic stable angina (Canadian Cardiovascular Society class-III) despite guideline directed medical treatment. Coronary arteries were cannulated with difficulty showing critical lesion of proximal left anterior descending artery (LAD). During angiography, diagnostic catheter has a peculiar cobra loop in the ascending aorta. As the left subclavian artery also has critical lesion at the proximal part, percutaneous coronary intervention of proximal LAD artery was successfully performed with 3.5×23 mm Xience Prime Everolimus eluting stent (Abott, USA) through right femoral route. Multi detector computed tomography (MDCT) contrast aortography showed the origin of the right subclavian artery in the right posterior side of the horizontal aorta with a tortuous course, proximal stenosis of left subclavian artery (LSC), and a bicarotid truncus. This abnormality can be easily detected by angiographic visualization, in the anteroposterior projection, of the angle of the catheter when it engages the ascending aorta, and by manual angiography at the ostium of the right subclavian artery. In such a case, selective catheterization of both coronary arteries may be very difficult, time consuming, and require more catheters. In such cases, one should not be hesitant to switch to transfemoral route if left radial route cannot be utilised.

Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter?

Background: Acute Kidney Injury as a complication of cardiac catheterization is associated with increased length of hospital stay and mortality. In recent years, the use of the radial artery for cardiac catheterization is increasing in frequency.Objective: The objective of this concise review was to evaluate the method of cardiac access site and its impact on Acute Kidney Injury following cardiac catheterization.Methods: After a thorough search on Medline, Google Scholar and PubMed, we included all the literature relevant to Acute kidney injury following transradial and transfemoral cardiac catheterization.Results: While acute kidney injury was caused due to a variety of reasons, it was important to consider each case on an individual basis. We found a trend towards increased use of transradial approach in patients at high risk of developing kidney injury. However, limitations such as operator experience, anatomical challenges and so on do exist with this approach.Conclusion: Transradial access offers several advantages to a patient at high risk of acute kidney injury undergoing cardiac catheterization. Further large studies are needed to establish this trend in the years ahead.

Impact of Transradial Catheterization on Vascular Function of the Brachial Artery Assessed by Flow-Mediated Dilatation.

Few studies have evaluated long-term vascular function after radial access catheterization. Furthermore, the impact of repeated catheterization remains unknown. We investigated flow-mediated dilatation (FMD) of the brachial artery after transradial catheterization. We prospectively enrolled 50 patients with suspected coronary artery disease referred for diagnostic coronary angiography. No ad-hoc percutaneous coronary interventions (PCI) had been performed at the time of the index procedure. In 30 patients (63.8%), PCI and/or repeated follow-up diagnostic catheterization were subsequently performed via the radial artery used at the index catheterization. FMD was successfully measured before catheterization, at 24 h after catheterization, and after long-term follow-up (mean, 32 months; range, 24-43) in 47 patients. FMD at follow-up was compared between patients receiving only one procedure and those receiving multiple procedures via the same arteries. FMD was significantly decreased after catheterization and recovered well in long-term follow-up (3.7 ± 1.6%, 3.0 ± 1.7%, and 3.9 ± 1.6%). There was no significant difference in follow-up FMD between the patients undergoing single catheterization and those with multiple procedures (3.4 ± 1.3 vs. 4.3 ± 1.7, p = 0.06). When the patients were divided into two groups according to the median follow-up FMD value, no significant predictive factor was identified for worse FMD. After transradial catheterization, FMD of the brachial artery temporarily decreased but recovered in long-term follow-up. Recovery of FMD was not jeopardized by repeated catheterization, which suggests the potential of the brachial artery to recover endothelial function after repeated transradial procedures.

ACUTE AXILLARY ARTERY OCCLUSION AFTER TRANSRADIAL CORONARY CATHETERIZATION

Axillary artery occlusion following transradial cardiac catheterization (TRCC) has not been previously reported. 89-year-old woman with known chronic atrial fibrillation and hypertension presented to the emergency department with chest pain. Physical exam revealed an irregular rhythm, radial and

La rilevazione e il trattamento del dolore durante le procedure di emodinamica e elettrofisiologia: uno studio descrittivo multicentrico

Coronary interventions and electrophysiology procedures may be painful both during and shortly after the procedure. To assess the onset of pain and anxiety in patient undergoing coronary interventions and electrophysiology procedures; to describe the administration (frequency, timing, dosage and outcomes) of analgesics and anxiolytics before, during and after the procedure. A descriptive multicenter study was carried out. Pain and anxiety were measured with a 10-point visual analogue scale (VAS) before, during, after the procedure and for the following 24 hours. Patient were asked to rate their satisfaction for the information received and pain control. Data on 230 patients were collected. The most performed procedure was the transradial coronary catheterization (68.7%). The pacemaker/defibrillator implantation resulted the most painful procedure (median 4, IQR 3-6) and also the most anxious (median 5, IQR 2-6). 13 Patients received an analgesic during the procedure for a low-to-severe pain; during the following 24 hours 34 patients (5 undergoing transradial coronary catheterization and 29 the implant of pacemaker/cardiac-defibrillator) suffered from severe pain and with the exception of 5, all requested pain relief. Satisfaction for pain control was inadequate for patients who underwent electrophysiology procedures and 55 patients would have needed more information on pain. Pain control and patient satisfaction may be improved, pre-procedural anxiety needs more attention and better information on the procedure should be provided.

100.74 Shared Decision-Making in Cardiac Catheterization: Race and Education Level as Predictors of Patient Knowledge of Risks and Benefits

Shared decision-making (SDM) has become a cornerstone of patient-centered medicine. In order to better understand SDM related to arterial access site choices, we studied patient understanding of risks and benefits associated with transradial (TRA) and transfemoral (TFA) cardiac catheterization. A

Radial anomalies in North Indian patients undergoing TRAns-radial catheterization: A prospective observational study (RAIN-TRAC study)

Background: Radial artery anomalies are relatively common and one of the major causes of transradial procedure failure. Aim: The study was aimed to assess the incidence of radial axis anomalies in patients undergoing transradial cardiac catheterization and their impacts on procedural failure. Materials and Methods: This was a prospective, single-center study, 1870 consecutive patients underwent transradial coronary catheterization. Radial artery anatomy was determined by injecting diluted contrast agent through radial sheath. Results: About 11.4% patients (213/1870) were noted to have abnormal radial artery anatomy which was associated with significantly higher procedural failure rate (odds ratio [OR] [95% confidence interval [CI] = 240.72 [57.98–999.43]) and radial artery spasm (OR [95%CI] = 7.12 [4.06–12.49]) than patients with normal radial artery anatomy. Among all the radial artery anomalies, high bifurcation was the most common anomaly, found in 128 (60%) patients. The high bifurcation was found most commonly at the mid-humerus level (53.12%). Extremely tortuous radial artery was found in 43 (20%) patients. Radial artery loop was found in 22 (10%) patients and was associated with the highest failure rate (54.5%). Other unclassified anomalies were found in 20 patients (10%). In bivariate analysis, the incidence of each of the radial artery anomalies was found to have significant correlation with older age, short stature, female sex, and hypertension. Conclusion: Radial artery anomalies are not uncommon and are related to significant procedural failure. Retrograde radial arteriography helps to identify patients with unfavorable radial artery anatomy, which can be performed with a minimum amount of contrast and should be considered part of a routine transradial procedure.

A volar ganglion cyst on the wrist imitating thrombosed radial artery pseudoaneurysm

A 57-year old male patient presented to the outpatient clinic with swelling in his left wrist causing pain and numbness in his fingers. The patient had undergone multiple cardiovascular angiographic interventions in the past. The first diagnosis was thrombosed radial artery pseudoaneurysm. The intraoperative diagnosis was the volar ganglion cyst. In this report, we emphasize the importance of the complications after transradial arterial catheterizations and present our experience.

Correlation Between Radial Artery Anomalies and Procedural Outcomes of Trans-radial Coronary Catheterisation

Correlation Between Radial Artery Anomalies and Procedural Outcomes of Trans-radial Coronary Catheterisation

Radial artery occlusion with a kaolin-filled pad after transradial cardiac catheterization.

Radial artery occlusion (RAO) occurs in 2% to 18% of patients after transradial access (TRA) cardiac catheterization. Using a kaolin-filled pad (QuikClot) reduces compression time during TRA and might reduce RAO. We examined the RAO risk with the kaolin-filled pad after TRA cardiac catheterization.This was a prospective cross-sectional study of 260 patients who underwent TRA cardiac catheterization in a cardiac ward of a Medical Center from 2012 to 2016. Patients were randomly assigned to 1 of 2 groups: the case group (n = 130) was postoperatively treated with a kaolin-filled pad, and the control group (n = 130) was treated with conventional hemostasis. Color duplex ultrasound was used to evaluate the 24-hour and 1-month postoperative radial artery flow velocity, diameter, patency, and RAO risk.RAO risk was not significantly different between the case and control groups after 24 hours (4.6% vs 5.4%, P = .776) or after 1 month (5.4% vs 6.1%, P = .789), regardless of whether it was a first TRA cardiac catheterization (after 24 hours [P = .153] or after 1month [P = .617], respectively) or a repeated TRA cardiac catheterization (after 24 hours [P = .754] or after 1month [P = .753], respectively).Using a kaolin-filled pad after TRA cardiac catheterization did not significantly reduce RAO risk compared with conventional hemostasis.

Hand Laser Perfusion Imaging to Assess Radial Artery Patency: A Pilot Study.

Objectives: To test a novel diagnostic technique to assess radial artery perfusion after transradial catheterization. Background: Despite being mostly asymptomatic, radial artery occlusion (RAO) is not a benign complication, and its diagnosis is frequently missed because it requires time-consuming diagnostic testing. We developed a novel operator-independent diagnostic test to assess RAO after coronary procedures through a transradial access (TRA) by means of hand Laser Perfusion Imaging (LPI). Methods: One hundred patients were evaluated before and after TRA by means of the LPI. A radial perfusion index (RPI) was calculated as the ratio between the total perfusion measured during ulnar occlusion and total basal perfusion. Vascular Duplex scan (VDS) was used as the standard of reference to assess the artery patency. Results: LPI correctly identified RAO in 100% of cases. Post-procedural RPI was 0.89 ± 0.13 in patients with radial patency vs. 0.15 ± 0.04 in patients with RAO (p < 0.001). In line with these results, ROC analysis showed an excellent diagnostic performance of the LPI, that correctly identified all RAO cases (Area Under the Curve, AUC = 1.0; p < 0.001), with an optimal diagnostic cutoff at 0.2 RPI. Conclusions: LPI is a reliable diagnostic technique for RAO, offering the advantages of being quick and simple to perform.

Clinical determinants of radial artery caliber assessed at the time of transradial cardiac catheterization using routine prospective radiobrachial angiography.

Transradial coronary angiography/intervention (TRA/TRI) is associated with reduced rates of bleeding, vascular complications, and major adverse cardiovascular events as compared to the transfemoral approach, but remains underutilized in the United States (U.S.). Small radial caliber is often cited as a technical impediment, however radial artery diameter (RAD) has not yet been systematically studied in the U.S. population using routine, prospective radiobrachial angiography. Consecutive patients (pts) with radiobrachial angiography acquired during TRA/TRI from September 2015 to August 2016 were retrospectively analyzed. Quantitative angiography (QA) was performed on digital subtraction angiograms. RAD measurements at distal (dRAD), mid (mRAD), and proximal (pRAD) segments, as well as minimum (minRAD) and maximum (maxRAD) diameters were indexed to radial arterial sheath size and tabulated. RAD measurements were adjudicated by 2 expert operators. Descriptive statistics and regression analyses were performed using STATA (College Station, TX). Of 175 radiobrachial angiograms, 2 were excluded due to uninterpretable QA. Woman had smaller RAD versus men: pRAD (3.11 vs 3.33 mm, p = 0.021), minRAD (2.36 vs 2.59 mm, p = 0.006), and maxRAD (3.32 vs 3.53 mm, p = 0.0195). Univariate analysis showed correlation between minRAD and gender (p = 0.012), age (p = 0.019), and weight (p = 0.008). However, after multivariate analysis, only gender was associated with minRAD (p = 0.05). This is the first study to describe the clinical determinants of RAD using prospective post-vasodilator, radiobrachial angiography in a U.S. Women had significantly smaller RAD across proximal, minimum, and maximum segments. Sex was the only multivariate predictor of minRAD.

Complex Hair pin loop in origin of radial artery- How to address the issue during transradial catheterization.

During transradial catheterization, sharp edge of the guiding catheter tip may act like a ‘‘razor-blade’’ and can hinder its navigation which is more common when one encounters radial artery loop, tortuosity, and radial artery spasm. Here, we report a case of 59-year old female who had a double hairpin turn with 360° loop at radio-brachial region. The loop was creating a ‘‘razor-blade’’ effect which was circumvented using balloon assisted technique and thus enabling tracking the diagnostic catheter, making procedure successful.

Pierwotna przezskórma interwencja wieńcowa za pomocą cewnika diagnostycznego typu Tiger w przypadku nietypowego odejścia gałęzi pnia lewej tętnicy wieńcowej

The use of smaller catheters for diagnostic and intervention purpose is becoming increasingly popular due to the shift towards transradial catheterisation. The use of smaller catheters permits smaller arterial punctures, which translates into early mobilisation and discharge, as it may obviate the need for closure devices, lesser contrast volume use, potential nephrotoxicity and decreased morbidity. Here, we report a case, where standard 5 F Tiger diagnostic catheters (Terumo Radifocus Optitorque, Japan) was used for primary percutaneous coronary intervention of left circumflex artery with abnormal take-off of the left main.

The Predictors of Post-Procedural Arm Pain after Transradial Approach in 1706 Patients Underwent Transradial Catheterization.

Although patients prefer radial over femoral approach, some develop post-procedural arm pain after transradial procedures. This complication has been poorly defined in prior studies. We evaluated the extent of non-ischemic arm pain after transradial arterial access and identify variables that may be associated with this complication. We performed a retrospective analysis of a 1706 patient database on patients who underwent transradial catheterization at three experienced radial centers. Arm pain was assessed by adult visual analogue scale (score > 4) defined as moderate to severe pain at the accessed forearm not related to hand ischemia and was evaluated at one day after the procedure. Logistic regression was used to identify the predictors of post-procedural arm pain. The overall incidence of post-procedural arm pain one day after a transradial procedure was 4.5%. Covariate associated with post-procedural arm pain were hemostasis compression >4 h (odds ratio (OR) = 29.47, p < 0.001), radial artery occlusion by Doppler evaluation (OR = 3.35, p < 0.001), radial artery diameter < 2.8 mm (OR = 2.66, p = 0.01), and multiple puncture attempts (OR = 2.31, p = 0.03). Approximately 1 in 20 patients undergoing transradial procedure have post-procedural arm pain one day after the procedure. Predictors of this complication relate to radial hemostasis, radial artery occlusion, radial artery diameter, and number of access attempts.

Prone transradial catheterization for combined single-session endovascular and percutaneous interventions: approach, technical success, safety, and outcomes in 15 patients

We aimed to report approach, safety, technical success, and clinical outcomes of prone trans- radial access (PTRA) and demonstrate feasibility for procedures requiring simultaneous arterial intervention and prone percutaneous access. Fifteen patients underwent PTRA, seven females (47%) and eight males (53%), mean age of 55 years (range, 19-78 years). All patients underwent PTRA for combined transarterial and posterior-approach percutaneous interventions. Variables included sheath size (French, F), type of anesthesia, arterial intervention technical success, posterior-approach percutaneous intervention technical success, estimated blood loss (mL), fluoroscopy and procedure time, complications, and follow-up. Mean sheath size was 4 F (range, 4-6 F; SD = 0.5). Arterial interventions included transarterial embolization of renal (n=6), hepatic (n=2), and pelvic vessels (n=2), diagnostic arteriography (n=4), and embolization of an arteriovenous malformation (n=1). Posterior-approach intervention technical success was 100% (15/15). PTRA technical success was 100% (15/15). Posterior-approach percutaneous interventions included retroperitoneal (n=5) and pelvic (n=1) mass biopsies, nephrostomy tube placement (n=2), cryoablation of pelvic (n=2) and renal (n=1) masses, sclerotherapy of arteriovenous malformations (n=2), foreign body removal from the renal collecting system (n=2), ablation of a renal tumor (n=1), intracavitary injection of pulmonary mycetoma (n=1), and ablation and cementoplasty of a vertebral body tumor (n=1). The biopsies were diagnostic (6/6). There were no minor or major access-site complications. PTRA is a safe and feasible method for performing combined arterial and posterior approach percutaneous interventions without the need for repositioning.

TCT-750 Radial Artery Occlusion - Incidence, Predictors and Long term outcome after TRAnsradial Catheterization: Clinico-Doppler ultrasound based Study (RAIL-TRAC Study)

To assess incidence, predictors and outcome of radial artery occlusion (RAO) after transradial catheterization (TRC) based on clinical and Doppler ultrasound study. A total of consecutive 1945 patients undergoing trans-radial catheterization for diagnostic or interventions were included. Radial

Effect of hemostatic device on radial artery occlusion: A randomized comparison of compression devices in the radial hemostasis study.

Asymptomatic radial artery occlusion (RAO) is a major limitation of transradial catheterization (TRC). Two radial compression hemostatic devices are compared for their respective effects on RAO. In a prospective, randomized, single center, blinded trial, 320 patients were randomly treated with a TR band (Terumo Corporation) or Safeguard Radial (Merit Medical). Institution wide protocols consisting of anticoagulation, patent hemostasis, duration of compression, and use of 6 French slender sheaths (Terumo Corporation) were observed. Patient discomfort related to the device was recorded using the universal pain scale. Radial artery patency was evaluated by reverse Barbeau's test prior to discharge (1-hour post-diagnostic catheterization or 6-24 hour post-intervention) and at 30-days. Of the 320 patients, 155 were randomized to the TR group (TRG) and 159 to the Safeguard group (SGG). 6 patients were excluded due to the inability to insert 6 Fr slender sheaths or patient withdrawing consent. Demographic and procedural characteristics were similar with the exception of the type of coronary procedure performed. Both bands were equally effective in achieving patent hemostasis. Despite having a higher rate of post-procedure hematoma (1.29% TRG vs. 3.1% SGG, p = 0.04) and acute RAO (3.8% TRG vs. 6.28% SGG, p = 0.05) with the Safeguard band, at 30 days RAO was similar in both groups (1.9% TRG vs. 2.5% SGG; p = 0.21). Patients in the SGG reported significantly less band discomfort and were found to require less air to achieve patent hemostasis. Evidence-based contemporary TRC protocols of using smaller diameter access, anticoagulation, and use of just enough pressure for the shortest duration of time to achieve hemostasis is associated with very low RAO rate at 30 days irrespective of the radial compression device used.