Transradial Coronary Angioplasty Research Articles

Evaluation of the safety and efficacy of the Axiostat® dressing device to achieve radial artery access hemostasis: The R3A study.

Radial access is the default approach in interventional cardiology. The Axiostat® surgical hemostatic dressing, using chitosan as its active component, has demonstrated potential in accelerating blood clotting. This study aims to assess the efficacy and the safety of the Axiostat® dressing in achieving hemostasis in patients undergoing transradial coronary angioplasty (TRCA). This prospective, single-center observational study, conducted in 2022, enrolled consecutive patients undergoing TRCA, with a target of 150 participants. The primary outcome was the success rate of radial artery hemostasis at 120 min, without bleeding necessitating immediate re-compression. The secondary outcome included Axiostat® performance at 24 h and 30 days Postprocedure. The study was terminated prematurely for ethical and patient safety reasons, after inclusion of 41 consecutive TRCA patients due to an unexpectedly high radial artery thrombosis rate (19.5%, n = 8/41) observed 24 h Postprocedure. The success rate of radial hemostasis with the Axiostat® dressing was 78.0%. Procedural details and patient characteristics were comparable between successful Axiostat® removal and device failure cases. The use of the Axiostat® dressing to achieve hemostasis after TRCA is effective but is associated with an unexpectedly high incidence of radial thrombosis. Our results should encourage caution in the future evaluation and use of this device for radial artery compression following TRCA.

Vascular dysfunction and its recovery after transradial coronary angioplasty- A serial observational study

ObjectiveTo serially evaluate the effect of trans-radial coronary angioplasty (TRA) on the vascular function of radial artery (RA) and upstream brachial artery (BA) and to find out the relative contribution of endothelial dependent flow-mediated vasodilatation (FMD) and endothelial independent nitrate mediated dilatation (NMD). MethodsForty patients of chronic stable angina with successful TRA were studied. FMD and NMD of bilateral RA and BA were measured with high-resolution ultrasound, before and at 24 h and at 3 months, after catheterization. ResultsFMD as well as NMD were significantly decreased in right RA (16.3 ± 3.6% to 5.7 ± 1.8%; p = 0.001, and 24.1 ± 5.3% to 9.7 ± 2.8%; p = 0.001, respectively) as well as in upstream BA (17.0 ± 1.6% to 9.4 ± 0.5%; p = 0.001,and 26.5 ± 6.8% to 20.5 ± 3.7%; p = 0.001, respectively) at 24 h. FMD/NMD ratio was also decreased in RA (70 ± 10% to 60 ± 10%; p = 0.04) and as well as in BA (70 ± 20% to 50 ± 10%; p = 0.03). The endothelial dysfunctions returned to normal at 3 months. Control arm did not show any change in vascular function at any point of time. Radial artery diameter/sheath ratio <1 and catheter exchanges >2 were the independent predictors for >50% decrease in FMD. ConclusionsTRA results in reversible depression in FMD as well as NMD in the radial artery as well as upstream brachial artery. These vascular dysfunctions are limited to the catheterized arm only and return to normal after 3 months.

Sigle-center, observational, prospective study describing same-day discharge implementation for uncomplicated elective percutaneous coronary intervention by radial approach: Study protocol

Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.

Successful Transradial Coronary Angioplasty in a Patient with Dextrocardia

Successful Transradial Coronary Angioplasty in a Patient with Dextrocardia

A Case Series of Two Traumatic Iatrogenic Radial Arteriovenous Fistulae as Complication of Transradial Coronary Angioplasty

BACKGROUND: Since the introduction of transradial access as a site for coronary angiogram or angioplasty, the rates of vascular complications have significantly improved. Because of this, the procedure has become increasingly preferred due to reduced morbidity rates and lower procedural cost. Complications—specifically, arteriovenous fistulae—have become rarer with the use of the transradial approach. This case series presents two cases of traumatic iatrogenic radial arteriovenous fistula as a complication of transradial coronary angioplasty, as well as their management. Case 1: A 59-year-old male who underwent coronary angioplasty due to left anterior descending coronary artery stenosis was noted to have a tender and pulsating mass proximal to the puncture site that started two weeks after the procedure. Bruit was noted on auscultation. A small fistula formation on the distal radial artery, draining to the connecting vein, was noted on ultrasound. Initial compression of the fistula was done for one week with no observable improvement, so the patient underwent surgical repair. Case 2: A 52-year-old female underwent successful coronary angioplasty. Successful hemostasis by compression of a transradial band (TR) over the access site was achieved post-percutaneous coronary intervention. Two weeks after the procedure, the patient complained of a palpable pulsatile mass on her right wrist. Duplex scan of the right forearm showed a small arteriovenous fistula connecting the radial artery to a deep branch of the radial vein. The fistula and swelling spontaneously resolved after compression with TR band for 48 hours. Conclusion: Traumatic iatrogenic radial arteriovenous fistula is a rare complication of a cardiac catheterization procedure using a transradial access approach. Conservative manual compression may be the initial treatment option, but surgical repair may be considered in the presence of hemorrhage, hemodynamic instability, painful limb ischemia, non-healing ulcers and functional impairment. Keywords: radial arteriovenous fistula, coronary angioplasty, transradial compression, surgical ligation.

Transradial Coronary Angioplasty in an Achondroplastic Patient with Chronic Total Occlusion (CTO): First Case Report

Transradial Coronary Angioplasty in an Achondroplastic Patient with Chronic Total Occlusion (CTO): First Case Report

TCT-751 Effect of Pigtail Assisted Tracking (PAT) of Guide Catheter During Transradial Coronary Angioplasty on Forearm Complications: A Prospective Randomized Trial

In transradial percutaneous intervention (PCI), the sharp edge of guide catheter tip may produce “Razor blade effect” leading to radial vascular injury. Recently, Pigtail Assisted Tracking (PAT) technique has been described to overcome it. Present study was done to prospectively evaluate the PAT

Safety and outcomes of day care based coronary angioplasty – First report from India

BackgroundThe concept of day care based coronary angioplasty might be frugal especially in countries like India where epidemic of coronary disease is enduring and healthcare delivery systems are limited. Published literature addressing the feasibility and safety of day care percutaneous coronary interventions (PCI) is lacking from our country. ObjectivesTo study the safety and outcomes in stable cardiac patients undergoing day care coronary angioplasty. MethodsA single centre nonrandomized active controlled trial of patients undergoing elective transradial coronary angioplasty and same day discharge after triaging was compared with a conventional arm of hospital overnight stay. ResultsFifty six patients with stable coronary artery disease underwent day care angioplasty. There were no major immediate adverse cardiac and cerebral events noted in the first 24 h. The procedural result followed by a 6-h observation period allowed adequate triage of patients to same-day discharge or to extended clinical observation. Apart from one possible stent thrombosis on day 3 in the treatment arm where the patent received fibrinolytic treatment in a local hospital, there were no major adverse cardiac or cerebral vascular events in the study group. The six month clinical follow up in the day care procedure group was also unevenful for any major adverse cardiac events. ConclusionThe study albeit small shows the feasibility and safety of day care PCI in the Indian scenario. It did not lead to additional complications compared with overnight stay. Triage of patients for an extended observation period can be performed adequately on the basis of clinical and procedural criteria.

Anterograde recanalisation of the radial artery followed by transradial angioplasty

We report a patient with critical hand ischemia after transradial coronary angioplasty. The radial artery occlusion was confirmed by angiography. The report discusses the role of angioplasty for the treatment of symptomatic radial artery occlusion.

Five-year experience with transradial coronary angioplasty in ST-segment-elevation myocardial infarction

Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI). The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study. Forty-three patients were excluded from the present study due to cardiogenic shock or rescue PCI. Patients (n=539) were categorized into the TR group (n=167) or the TF group (n=372), and several parameters were evaluated to assess the advantages and drawbacks of TR access: access-site crossover, rate of access-site complications, procedure time, fluoroscopy time, X-ray area dose, major adverse cardiac events (MACE) at 1 month, and consumption of angioplasty equipment. In the TR group, the crossover rate to femoral access was 5%, while in the TF group, it was 0.8% (P<.05). There was a significant difference, in both major and minor access-site complications, between the TR group and the TF group (0% vs. 5%, P<.05, and 4% vs. 9%, P<.05, respectively). Consumption of angioplasty equipment proved to be the same for the two groups. The MACE rate was 4% in the TR group and 11% in the TF group (P<.05). Our results suggest that the TR approach is a safe and effective way to treat STEMI; furthermore, site-related complications are less common with this approach.

Transradial approach for coronary angioplasty in Chinese elderly patients

The radial artery is currently regarded as a useful vascular access site for coronary procedures. This study was conducted to investigate the feasibility and safety of the percutaneous radial artery approach for angioplasty in the elderly. Two thousand and fifty-eight consecutive patients (762 elderly, age = 65 years; and 1296 non-elderly, age < 65 years, respectively) who underwent transradial coronary angioplasty were recruited in this study. Study endpoints included procedure success rate, procedure time, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization. Elderly patients were more likely to present with unstable angina and renal dysfunction. The incidence of radial and brachiocephalic trunk anatomical tortuosity was higher in elderly patients than that in non-elderly patients (11.5% vs 3.7%; 8.9% vs 2.6%, P < 0.01, respectively). However, procedural success rate (94.7% vs 95.6%) and total mean procedure time ((67.9 +/- 27.3) minutes vs (58.6 +/- 38.5) minutes) for transradial coronary angioplasty were not significantly different between the two groups. Clinical course during the hospitalization was slightly worse in the elderly patients because of more adverse cardiac and cerebrovascular events after the procedure. However, the incidence of vascular complications was not significantly different between the elderly and non-elderly patients. Although the incidence of radial and brachiocephalic trunk anatomical tortuosity is higher in elderly patients, transradial coronary intervention can be performed with similar safety and procedural success in these patients as compared with non-elderly patients.

Drive-Through Angioplasty

In this issue of Circulation , Bertrand et al1 report the results of the Early Discharge after Transradial Stenting of Coronary Arteries (EASY) Study. After receiving a standard bolus of abciximab and undergoing a successful and uncomplicated transradial stent placement, 1005 patients were randomized to a traditional strategy with overnight hospitalization or early discharge after 4 to 6 hours. All patients received aspirin, clopidogrel, and a bolus dose of abciximab before their procedure. Those in the traditional strategy group also received a 12-hour abciximab infusion, whereas those in the early discharge group did not. The goal of the EASY study was to show that stent implantation by the radial approach with only a bolus of abciximab and then early discharge was not inferior to the traditional strategy in terms of effectiveness and safety. The primary composite end point was the 30-day incidence of death, any myocardial infarction, unplanned revascularization, major bleeding, repeat hospitalization, access-site complications, or severe thrombocytopenia. On the basis of their data, the authors concluded that the abbreviated abciximab therapy with same-day discharge was clinically not inferior to the traditional strategy after uncomplicated stent placement. Article p 2636 With healthcare costs increasing, strategies to limit expenditures are popular and deserve careful examination. Accepted cardiology practice has moved toward dramatically shortened hospital stays for diagnostic coronary angiography and percutaneous coronary intervention (PCI) as well as many other procedures. The present study suggests that many patients who undergo PCI could be managed safely as outpatients. Substantial accomplishments in the practice of PCI have resulted in the excellent success and safety of the procedure we now observe, but are we ready for routine outpatient PCI? The use of radial artery access has been well described in the literature. Despite studies demonstrating the feasibility, safety, and acceptance by patients of this …

The use of multiple “buddies” during transradial angioplasty in a complex calcified coronary tree

We report our experience in transradial coronary angioplasty on a tortuous, calcified coronary tree in a patient who had been turned down for surgical revascularization. In view of the complexity of the coronary anatomy, successful completion of the procedure required plaque modification with the use of rotational atherectomy in the left anterior descending coronary artery, and the use of an inflated buddy balloon in the circumflex artery. The latter represents a novel, simple, and inexpensive technique, which may allow successful advancing of coronary stents in calcified and tortuous coronary arteries.

Day case transradial coronary angioplasty: A four-year single-center experience

We examined the safety and feasibility of elective outpatient transradial coronary angioplasty (PCI). Four hundred and forty two patients underwent procedures over a 4-year period. Over 95% had an excellent angiographic result and 85% were discharged the same day. Radial access was successful in 417 (94%) patients. There were no major vascular complications. One patient died of a subacute stent thrombosis. Outpatient transradial PCI is safe and feasible for the majority of elective PCI cases.

Acute compartment syndrome after transradial coronary angioplasty

In the May 15, 1998 issue of Int. J. Cardiol., HildickThe injured radial artery was repaired. She was discharged 1 Smith et al. [1] demonstrated the high success rate of coronary angiography from the radial artery. Transradial cardiac catheterization is widely accepted now. The nearly absence of local vascular complication is one of its characteristics. The use of enoxaparin in patients with acute coronary syndrome became more and more popular. In the August 2001 issue of Int. J. Cardiol., Collet et al. [2] suggested that the dosage of subcutaneous low molecular weight heparin enoxaparin should be reduced in patients with severe renal failure. We reported a case of acute compartment syndrome within 24 h after transradial coronary intervention. Enoxaparin was prescribed in this patient. This 84-year-old female patient had hypertension and diabetes mellitus for 20 years. She was admitted for acute non-ST elevation myocardial infarction on March 24, 2002. Balloon angioplasty was performed smoothly by right radial artery approach on March 28, 2002. The arterial sheath was removed immediately after angioplasty. The puncture site was compressed by the hemostasis device SteptyP (Nichiban) for 6 h and plastic bandage till the next morning. We gave 60 mg enoxaparin every 12 h after angioplasty. Her body weight was only 45 kg. However, local swelling and hematoma at puncture site developed abruptly the next morning. Patient complained of right forearm pain. Even under the direct manual compression and administration of fresh frozen plasma, it progressed and extended to the elbow. Hypotension developed later. Under the diagnosis of radial artery bleeding with acute compartment syndrome of right forearm, she received fasciotomy. The operative finding confirmed the diagnosis.

Acute compartment syndrome after transradial coronary angioplasty

In the May 15, 1998 issue of Int. J. Cardiol., Hildick-Smith et al. [1] demonstrated the high success rate of coronary angiography from the radial artery. Transradial cardiac catheterization is widely accepted now. The nearly absence of local vascular complication is one of its characteristics. The use of enoxaparin in patients with acute coronary syndrome became more and more popular. In the August 2001 issue of Int. J. Cardiol., Collet et al. [2] suggested that the dosage of subcutaneous low molecular weight heparin enoxaparin should be reduced in patients with severe renal failure. We reported a case of acute compartment syndrome within 24 h after transradial coronary intervention. Enoxaparin was prescribed in this patient.

Feasibility and Problems in Transradial Coronary Angiography and Intervention

Background and Objectives:The transradial coronary angiography and intervention is on the increase with its satisfactory results. It gives advantages of reduced vascular complication and increased comfort of patients. We evaluated the feasibility and problems of transradial coronary angiography and intervention as a routine procedure. Materials and Method:Between February 1998 and December 1999 transradial approach was attempted in 750 patients with normal Allen test. Radial angiography was performed to assess the radial artery spasm and tortuosity. Arterial sheath was removed immediately after the procedure and vascular complications were evaluated before discharge. Results:Radial artery puncture was successful in 738 (98%) patients. Transradial coronary angiography was successful in 719 (96%) patients. We failed in coronary angiography in 19 patients and the main reasons were tortuous subclavian artery in 11 patients and radial artery spasm in 5 patients. Transradial coronary angioplasty was performed successfully in 185 (95%) of 194 patients. In 9 patients intervention was switched to transfemoral approach because of tortuous subclavian artery. Complications were severe radial artery spasm in 13 (1.8%), minor subcutaneous hemorrhage in 7 (0.9%), non-ischemic radial artery occlusion in 4 (0.5%) and radial artery perforation in 1 (0.1%). But, there were no major complications requiring vascular surgery or transfusion. Conclusion:Transradial coronary angiography and intervention might be useful and safe as a routine procedure. The major limitations in transradial approach were radial artery spasm and toruosity of brachial or subclavian artery. (Korean Circulation J 2000;30(9):1083-1091)