Transradial Coronary Angiography Research Articles

A-28 | The Comparison of Using Single Versus Two-Catheter Concept in Diagnostic Trans-Radial Coronary Angiography: A Single-Community Center Experience

A-28 | The Comparison of Using Single Versus Two-Catheter Concept in Diagnostic Trans-Radial Coronary Angiography: A Single-Community Center Experience

Undesirable complication after transradial coronary angiography: A case report

Radial artery is one of the intervention cites for coronary angiography and has an increased tendency according to the successful results in the literature. However, some undesirable clinical situations may occur by using this route as with every invasive intervention. In this study, we presented a patient who had left upper limb ischemia following transradial angiography. An intimal flap with an approximate length of 15 cm was removed during embolectomy from the brachial artery. After multiple embolectomy procedures, axillo-brachial bypass was performed using the saphenous vein. However, ischemia in the forearm did not improve and limb loss occurred.

The optimal puncture time point of prolonged occlusion flow-mediated dilatation in radial artery catheterization: a prospective observational study

Previous studies have demonstrated prolonged occlusion flow-mediated dilatation (PO-FMD) could reduce cannulation failure rates and decrease radial artery pulsation loss during trans-radial coronary angiography. However, the time and degree of radial artery dilatation induced after PO-FMD were unclear. This study aimed to evaluate the degree and duration of the radial artery dilation after PO-FMD, and the time point at which the radial artery diameter is expanded to the maximum. This was a prospective observational study. According to the Chinese guideline on the primary prevention of cardiovascular diseases, 142 patients awaking from general anesthesia were divided into two groups: low-risk (LR) group and high-risk (HR) group. Firstly, the baseline radial artery diameter was measured on the left wrist using ultrasound in both groups. Subsequently, the radial artery diameters were obtained continuously at the same location for 5 min after PO-FMD. The baseline radial artery diameter, the maximum radial artery diameter, and the duration of radial artery dilation in the two groups were recorded. The time point at which the radial artery diameter is expanded to the maximum in the LR group and HR group was 26.49 ± 11.69 s and 46.27 ± 12.03 s, respectively (P < 0.01). The time of radial artery dilation and the percentage changes in arterial diameter in HR group were significantly lower than LR group (duration time: mean [mean ± standard]: 136.65 ± 31.55 s vs. 168.98 ± 33.27 s; percentage changes: median [interquartile range] 10.5 [8.6, 12.9] % vs. 15.2 [12.4, 19.0] %). In this study, the optimal puncture time point of PO-FMD in the LR group was 26 s, and in the HR group was 46 s. It would be helpful to guide the time point in radial artery catheterization after PO-FMD.Chinese Clinical Trial Registry identifier: ChiCTR2200066214.

Is single-catheter technique for coronary angiography an optimal tool for beginners in interventional cardiology?-randomized controlled study TRACT 2: Transradial Coronary Angiography Trial 2.

Transradial coronary angiography can be performed using a dual-catheter technique (DCT) or single-catheter technique (SCT). The current study aimed to compare DxTerity SCT Ultra and the Trapease curve SCT catheters with DCT catheters in procedures performed by young, less experienced, interventional cardiologists. For this prospective, single-blinded, randomized study 107 were enrolled and assigned to 1 of 3 groups. They underwent planned coronary angiography at the Second Department of Cardiology Jagiellonian University in Kraków. In groups 1 (n=37) and 2 (n=35), DxTerity SCT Ultra catheters and the Trapease curve were used, respectively. In control group 3 (n=35), standard DCT Judkins catheters were applied. One patient was excluded from group 2, bringing the total number of cases analysed to 106. The study endpoints comprised the percentage of optimal stability, proper ostial artery engagement, a good quality angiogram, the duration of each procedure stage, the amount of contrast and the radiation dose. The highest percentage of optimal stability was observed in group 1 for the right coronary artery (RCA): 94%, and in group 3, for the left coronary artery (LCA): 85%. The necessity to change the catheter was most common in group 2. Group 1 was characterised by a shorter total procedural time. The contrast volume was higher in group 2, while there were no differences in radiation dose. SCT is at least as adequate as DCT for young cardiologists. SCT was associated with lower necessity of catheter exchange during RCA visualization. The DxTerity Ultra curve catheter allows shortening the total procedure time.

Radiation Dose in Coronary Angiogram: A Comparison of Radial and Femoral Approach

Background: Many clinical trials have demonstrated the benefit of trans-radial access (TRA) over trans-femoral access (TFA) in reducing mortality and bleeding events, but there is some concern about radiation exposure with radial access. Objective: To assess the difference in radiation exposure between radial and femoral approach as measured by dose-area product (DAP) and fluoroscopy time. Methods: This cross-sectional study was performed in patients aged 15 years and above who underwent invasive percutaneous coronary angiography at Ramathibodi Hospital between December 2019 and December 2020. Exclusion criteria included previous coronary artery bypass graft, unstable hemodynamic status during procedure, and changing the access site or using access sites other than femoral or radial arteries. Demographic data of patients was collected through medical records. DAP and fluoroscopy time of patients with radial and femoral approach were evaluated. Results: Of 427 patients (49.4% male wtih mean age of 65.7 years), 245 (57.4%) patients underwent TFA. There was no significant difference in the median DAP between the radial and femoral approach (radial 1838 mGy.cm2 vs femoral 1690.7 mGy.cm2, P = .31). However, the fluoroscopy time was significantly higher in radial approach group (radial 4.6 min vs femoral 3.3 min, P &lt; .001). Conclusions: The radiation exposure was not significantly different between trans-radial and trans-femoral coronary angiography.

Does the Use of Ethyl Chloride Spray Facilitate Radial Angiography?

Ethyl chloride (EC) spray is a vapocoolant which is used in interventional procedures as a topical local anesthetic. The aim of the present study was to investigate whether or not EC spray can facilitate radial coronary angiography. The study was conducted on a study group EC of 106 (age: 58.1 ± 12.4) patients and a control group (placebo) of 104 (age: 59.1 ± 10.8) patients. Visual analogue scale scores (VAS), radial cannulation failure (RCF), the rates of clinical and anatomical radial artery spasm (RAS), pain lasting >2day and >1 week, and radial artery occlusion (RAO) at first week and first month were evaluated in both groups. VAS scores, the rates of RCF, clinical and anatomical RAS and pain lasting >1week were found significantly lower in the study group than the control group (p < .001, p = .024, p=.009, p = .028 and p = .042, respectively). But the rates of RAO were similar in both groups. Topical spray including EC, which has low-cost and rapid efficacy, may be preferred in transradial coronary angiography as it reduces the risk of RCF and RAS, and increases patient comfort with its analgesic effect, without significant side-effects.

The Treatment Role of Anti-aggregants and Anti-coagulants in Radial Artery Occlusion after Transradial Coronary Angiography

The Treatment Role of Anti-aggregants and Anti-coagulants in Radial Artery Occlusion after Transradial Coronary Angiography

Clinical and Radiographic Predictors of Successful Coronary Angiography Through Right Radial Artery Access.

Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated with a higher diameter of the aortic knuckle (Group IV, 4.09 ± 1.32 cm versus Groups I, II and III combined, 3.26 ± 0.98 cm; p=0.015) and the width of the mediastinum (Group IV, 8.96 ± 2.88 cm versus Groups I, II and III combined, 7.28 ± 1.78 cm; p=0.009). The cut-off value for prominent aortic knuckle was 3.55 cm (sensitivity 70% and specificity 67.35%) and the width of mediastinum was 6.59 cm (sensitivity 90% and specificity 42.86%). Conclusion: Radiographic prominent aortic knuckle and wide mediastinum are valuable clinical parameters and useful predictors for transradial access failure caused by tortuosity of the right subclavian/brachiocephalic arteries or aorta.

Finger exercise could reduce painfulness and radial artery complications related to coronary artery angiography.

To estimate if applying a finger exercise during trans-radial coronary artery angiography (CAG) could help to reduce a patient's painfulness and evaluate its protective effects against radial artery complications. This is a prospective, controlled, single-center trial. Overall, 390 patients who underwent coronary angiography through radial path in our hospital during 2022 were randomized 1 : 1 to the following two groups: test group: finger exercise in addition to routine perioperative care; control group: routine care. The success rate of radial puncture, the incidence of procedural radial artery dissection (RAD) and radial artery spasm (RAS), change of wrist circumference, pain degree related to the operation, occurrence of access site hemorrhagic complications, hemostasis time and postprocedure occurrence of radial artery occlusion (RAO) before discharge were recorded and compared between two groups. Compared to the control group, the test group had a higher success rate of radial puncture, lower incidence of RAS, RAD and RAO, slighter swelling of wrist and patients who felt less pain in the test group. There was no difference in prolonged hemostasis time or hemorrhagic complications between the two groups. Finger exercise could help to make a patient more comfortable and reduce radial artery complications related to CAG.

Correlation of a guidewire maximum insertion length with tortuous radial artery and the success rate during transradial coronary angiography

BackgroundPercutaneous coronary intervention (PCI) is a safe and effective therapy for patients with obstructive coronary artery disease (CAD). We aimed to assess the correlation between the success rate of angiography and the maximum insertion length and resistance of a soft-tipped guidewire.MethodsFive hundred twenty-one patients were treated by successful radial artery puncture. According to whether the guidewire resistance, the patients were divided to three groups. 17 patients were maximum insertion length of guidewire ≤ 30 cm when resistance was encountered (group 1). 17 patients were maximum insertion length of guidewire between 30 and 45 cm when resistance was encountered (group 2). 487 patients were no resistance encountered (group 3).ResultsThe coronary angiography success rates of group 1, 2, and 3 were 52.94%, 47.05%, 98.97%, respectively. Typically, angiography can be completed in patients with Ω-shaped, S-shape or Z-shaped tortuosity.ConclusionsThe maximum insertion length of straight guidewire and resistance can be used to determine radial artery status. The radial artery tortuosity or spasm significantly affects the success rate of coronary angiography.

Severely Kinked Catheter Removal After Transradial Coronary Angiography: Sometimes Surgery is Unpreventable

A 68 year old patient was referred after diagnostic transradial coronary angiography with a stuck catheter (Judkins Right 4.5, Cordis, Miami-Lakes, USA) in the proximal radial artery (A). Endovascular removal attempts (stretching, different guidewires) by the cardiologist were unsuccessful. An open surgical approach at the level of the elbow revealed a severely kinked catheter, stuck in the intimal layer of the radial artery (B). After removal, the intimal flap was corrected with a bovine patch. Post-operative duplex showed no diminished flow to the hand. Even though there are several endovascular removal techniques (stretching, balloon, or opposite rotation manoeuvres), surgical extraction is sometimes needed.Image 1

CASE REPORT OF PSEUDO-WELLENS’ SYNDROME AND MYOCARDIAL BRIDGING IN A YOUNG WOMAN

The clinical entity in which Wellens' electrocardiographic changes occur in normal coronary arteriesconfirmed by angiography is defined as Pseudo Wellens syndrome. Myocardial bridging is a condition wheremuscle fibers abnormally bridge the intramyocardial passage of an epicardial coronary artery, which subsequentlybecomes a tunneled pathway beneath them. It is most commonly found in the middle segment of the left anteriordescending artery (LAD) (70% to 90% of cases). It is recognized as the most common congenital coronary anomaly.Case report: A 49-year-old woman came to the emergency room because of tightness in her chest that she had a fewmonths ago, but today is more pronounced. After consultation, she was hospitalized at the cardiology department forfurther treatment and investigation. An electrocardiogram showed sinus rhythm with inverted T waves in precordialleads V2 to V5. She underwent distal transradial coronary angiography on the same day, which revealed mid-LADsegment systolic compression (10 mm) consistent with myocardial bypass.The clinician should be aware of MB as a potential cause of pseudo-Wellens syndrome and in the differentialdiagnosis of inverted T waves in a young subpopulation at presentation of acute coronary syndrome.

Incidence and predictors of radial artery occlusion following transradial coronary angiography: the proRadial trial

ObjectivesThis study investigated the contemporary incidence and predictors of radial artery occlusion as well as the effectiveness of antithrombotic treatment for radial artery occlusion following transradial coronary angiography.BackgroundThe radial artery is the standard access for coronary angiography and even complex interventions. Postprocedural radial artery occlusion is still a common and significant complication.MethodsThis prospective study enrolled 2004 patients following transradial coronary angiography. After sheath removal, hemostasis was obtained in a standardized fashion. Radial artery patency was evaluated by duplex ultrasonography in all patients. In case of occlusion, oral anticoagulation was recommended and patients were scheduled for a 30-day follow-up including Doppler ultrasonography.ResultsA new-diagnosed radial occlusion was found in 4.6% of patients. The strongest independent predictors of radial occlusion were female sex and active smoking status. In the subgroup of patients with percutaneous coronary interventions, female sex followed by sheath size > 6 French were the strongest predictors of radial occlusion. 76 of 93 patients with radial occlusion received an oral anticoagulation for 30 days. However, reperfusion at 30 days was found in 32% of patients on oral anticoagulation.ConclusionThe incidence of radial artery occlusion following coronary angiography in contemporary practice appears with 4.6% to be lower as compared to previous cohorts. Female sex and smoking status are the strongest independent predictors of radial occlusion followed by procedural variables. The limited effectiveness of oral anticoagulation for treatment of radial artery occlusion suggests a primarily traumatic than thrombotic mechanism of this complication.Graphical abstract

The protective role of low-dose acetylsalicylic acid use and relation with inflammatory and thrombotic parameters on radial artery occlusion in patients undergoing elective transradial coronary angiography

Aim: Transradial angiography (TRA) is recommended in clinical practice; it is better than the transfemoral route to prevent site-related complications. Radial artery occlusion is one of the most seen significant complications after TRA. In the present study, the protective effect of low dose acetylsalicylic acid (ASA) use against the radial artery occlusion (RAO) and the predictive ability of some thrombotic and inflammatory factors for the development of RAO were investigated.&#x0D; Material and Method: One thousand two hundred fifty-four patients who planned for elective coronary angiography were screened to include transradial coronary angiography. The patients have grouped group I, who took ASA (100 mg) (n= 56), and group II (n= 51), who did not. Blood samples were taken immediately after sheath insertion and after the six hours of the sheath removal. The D-dimer and C-reactive protein values were analyzed between groups. In the first 24 hours after the procedure, the radial Doppler ultrasonography assessment was performed to detect RAO. Multivariable regression analysis was used to evaluate the independent risk factors for the TRA.&#x0D; Results: Eligible one hundred seven stable patients were included in the study. The demographic, laboratory and procedural characteristics were similar between the two groups (Table 2). TRA was statistically lower in Group I compared to Group II. (n=3 vs. n=22, p=.001). Multivariable regression analysis demonstrated that postprocedural higher D-dimer levels and non-ASA status were found to be the independent risk factors for RAO (OR (95% CI=1.235(1.014-1.582) p=.001, 5.534 (3.376-9.252), p .05).&#x0D; Conclusion: Preprocedural ASA use may have a protective role against the RAO. Pre- and post-procedural D-dimer levels can predict the thrombotic process in the early phase of the RAO.

Right and left coronary artery angiography with single Judkins left catheter via right radial artery

Objectives: The aim of this study was to assess the safety and efficacy of single Judkins left (JL) catheter to view right and left coronary artery in right transradial coronary angiography. Methods: A total of 266 patients underwent coronary angiography from the right radial artery were studied prospectively. Patients with ad-hoc percutaneous coronary intervention (PCI), peripheral angiography, ventriculography or aortography procedures (67 patients) were excluded from the study. Coronary angiography was performed with the JL catheter as single catheter group in 171 of the remaining 199 patients, and with the Judkins right and left catheters as the control group in the other 28 patients. Complications, procedure success, procedure time and fluoroscopy time were evaluated between the two groups. Results: Procedure success were 93% (159/171) in patients with a single catheter group and 96.4% (27/28) in patients with two catheter (Judkins right and left) group (control group) (p = 0.49). Complications (spasm) are the same between the two groups (8 of 171 [4.7%] patients in study group and 1 of 28 [3.6%] patients in control group, p = 0.79). Fluroscopy time in single JL catheter group was significantly higher (6.20 ± 4.97 min vs 3.76 ± 2.78 min, p = 0.01). Conclusions: Single JL catheter using to view right and left coronary artery in right transradial coronary angiography was safe and effective. In our study, the success rate of getting left and right coronary artery images with a single JL catheter as high as 93%. However, insisting on imaging with a single catheter extends the duration of fluoroscopy time.

Different Antiplatelet Strategies for Radial Artery Protection After Transradial Coronary Angiography-A Prospective Observational Cohort Study.

IntroductionRadial artery occlusion (RAO) after transradial access is a common thrombotic complication. A meta-analysis has proven that RAO incidence in transradial coronary angiography (TRCA) settings was significantly higher than that in percutaneous coronary intervention settings. This prospective observational cohort aimed to evaluate radial artery protection after TRCA with different antiplatelet strategies.MethodsA total of 2,316 patients undergoing TRCA was enrolled and divided into two groups: single-antiplatelet and dual-antiplatelet groups. Radial artery patency was evaluated by ultrasound before, at 24 h, and 30 days after TRCA. The primary endpoint was RAO incidence at 30 days after TRCA.ResultsA total of 66 RAO was found on ultrasonography at 30-day follow-up (incidence: 2.8%). In the dual-antiplatelet group, the rate of RAO was significantly lower compared with the single-antiplatelet group (1.8 vs. 4.0%; odds ratio (OR): 0.41; 95% confidence interval (CI): 0.24–0.70; p = 0.001). The rate of self-recanalization in the dual-antiplatelet group was significantly higher than that in the single-antiplatelet group (73.68 vs. 44.12%, p < 0.001). However, there was no statistical difference in delayed occlusion of radial artery between the two groups (0.5 vs. 0.2%, p = 0.140). Unexpectedly, this study also showed no significant difference in bleeding risk between the groups.ConclusionDual-antiplatelet therapy for 1 month after TRCA was associated with a reduced risk of RAO and deemed safe.

The relationship between radial artery spasm and adropin levels in patients undergoing transradial coronary angiography.

Introduction: Transradial coronary angiography (TRA) is associated with a lower incidence of bleeding rate and access site complications and is associated with better outcomes compared to transfemoral angiography. However, radial artery spasm (RAS) is an important limitation of TRA procedures. Little is known regarding the relationship of serum vasodilator and inflammatory markers with RAS. Therefore, the present study aimed to investigate the association between serum adropin level and RAS in patients undergoing TRA. Methods: From February 2020 to January 2021, 39 consecutive patients who underwent elective daiagnostic TRA and experienced RAS during the procedure, and 42 age and sex matched controls who did not experience RAS were prospectively included into the study. The groups were compared regarding serum adropin levels and inflammatory markers.Results: Although adropin levels were found to be lower in the RAS group, this difference was not statistically significant between the the patients with RAS and controls (14.9 vs. 16.1, P=0.105). However, inflammatory parameters monocyte count and MHR (monocyte/HDL cholesterol ratio) were found to be statistically significantly higher in the RAS group compared to controls (P=0.001 and P=0.010, respectively). Moreover, a significant positive correlation was found between the monocyte count and RAS (r:0.360, P<0.001), and between MHR and RAS (r:0.288, P=0.009). Furthermore, multivariate analysis demonstrated that monocyte count (OR:1.671, 95%CI:1.312-2.094, P=0.001) and MHR (OR:1.116, 95%CI:1.054-1.448, P=0.022) were found to be independent predictors of RAS. Conclusion: Serum vasodilator and inflammatory markers may be useful in the prediction of RAS in patients undergoing TRA procedures.

Transradial Artery Approach for Diagnostic Coronary Angiography: Immediate Clinical and Procedural Outcome

Background: The transradial approach has emerged as an attractive alternative to the femoral approach for coronary angiography. In the hands of experienced operators, transradial coronary angiography offers improved patient comfort and decreased access-site complications. Objectives: To evaluate the immediate clinical &amp; procedural outcome of transradial approach for coronary angiography. Methodology: This is a descriptive cross sectional study carried out in a tertiary cardiac center .The transradial approach was attempted in patients with a good radial pulse and normal Allen test. This study enrolled 70 patients who underwent coronary angiography during the period from October 2012 to April 2013. Result: The transradial approach was attempted in 70 Patients. The preferred side for transradial approach was the right side in all cases. The procedure success was 91.4%. Failure of puncture or canulation of the radial artery was the main cause of failure rate, followed by subclavian tortuosity and radial artery spasm. No minor or major vascular complications due to the procedure apart from one patient (1.4%) who got small superficial hematoma in the forearm. The average time for successful canulation was 4.8± 3.9 min (range 3.3 to 8.1 minutes), and that of the catheterization procedure was 33.12 ± 11.2 minutes (range 20-60 min.). Conclusion: The transradial approach for coronary angiography is a safe and effective alternative to femoral approach. Keyword: Transradial approach; coronary angiography.

Gender-Specific Performance of One- Compared to Two-Catheter Concepts in Transradial Coronary Angiography – Insights From the Randomized UDDC-Radial-Trial

ObjectivesThe present sub-analysis from the randomized UDDC-Radial-Trial sought to compare one-catheter concepts (OCC) with two-catheter concepts (TCC) in different patient subgroups, particularly in those depending on gender and age. BackgroundThere is an ongoing debate regarding potential performance differences of OCC compared to TCC for transradial coronary angiography in specific patient subgroups. MethodsThe randomized UDDC-Radial-Trial enrolled a total of 300 patients planed for coronary angiography in a 2:1 ratio to either OCC by Tiger II (n = 100) and BLK (n = 100) or TCC by Judkins (n = 100) catheters. Predefined patient subgroups stratified for age, gender and patient constitution were analyzed with regard to the primary outcome measure of time required for a complete coronary angiography. ResultsIn male patients time for coronary angiography was significantly shorter in the TCC group compared to the OCC group (510 ± 37 s vs. 615 ± 35 s; p = 0.046). No difference between the catheter concepts was observed in the subset of female patients (525 ± 34 s vs. 583 ± 54 s; p = 0.43). TCC was associated with shorter coronary angiography time in patients aged <71 years compared to OCC (462 ± 23 s vs. 570 ± 38 s; p = 0.018). In patients ≥72 years of age no difference was detected (573 ± 41 s vs. 636 ± 45 s; p = 0.31). Other subgroups showed no relevant differences in angiography time among OCC and TCC. ConclusionsThe present subgroup analysis from the UDDC-radial trial demonstrates the use of OCC in transradial diagnostic angiography to be inferior compared to TCC in terms of angiography time in younger and male patients.

B-47 | Comparison of Three Commonly Used Catheter Strategies in Transradial Coronary Angiography

Transradial technique is the standard of care with a class 1A indication. Studies have compared single vs. dual catheter approaches, yet there is paucity of literature comparing the 3 commonly used strategies for transradial coronary angiography, single-catheter Tiger (T) or Jacky (JA) or dual-catheter Judkins (JU).