Transradial Coronary Intervention Research Articles

Nursing of forearm hematoma after transradial coronary intervention.

Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. By observing, describing, and analyzing the pictures taken during clinical diagnosis and consultation, we summarize the prevention, treatment, and nursing of forearm hematoma after percutaneous coronary intervention, to provide reference for the nursing of patients with forearm hematoma. We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma. Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma, providing reference for the prevention and management of forearm hematoma in clinical practice. For patients undergoing transradial coronary intervention, the three key time points for preventing hematoma and symptomatic management based the risk classification of forearm hematoma are crucial.

Effects of Transradial Access on In-Hospital Outcomes in Percutaneous Coronary Intervention for Coronary Artery Bypass Graft: Insights from the Japanese Nationwide Database

Due to its superior safety profile and improved outcomes, trans-radial percutaneous coronary intervention (TRI) has become the preferred access in percutaneous coronary intervention (PCI) of native coronary disease. This study investigated the impact of TRI on in-hospital outcomes after PCI for coronary artery bypass graft vessels (GV-PCI). We analyzed patients who underwent GV-PCI in 2019–2022 from the Japanese nationwide registry. Patients were categorized into the TRI and trans-femoral percutaneous coronary intervention (TFI) groups. We assessed the association of TRI and in-hospital outcomes. The primary outcome was a composite of in-hospital death and major bleeding. GV-PCI was performed in 2,295 Out of 972,370 total PCI procedures. The primary outcomes occurred in 29 patients (1.3%), including 17 deaths (0.7%). Major bleeding occurred in 12 patients (0.5%), and access site bleeding in seven patients (0.3%). The TRI group (N=1,521) showed lower crude rates of the primary outcome (0.9% vs. 1.9%, p = 0.039), major bleeding (0.3% vs. 1.0%, p = 0.027), and access site bleeding (0.1% vs. 0.6%, p = 0.047) compared to the TFI group (N=774). Univariable logistic regression demonstrated a significant association of TRI with reduced primary outcome (odd ratio (OR):0.47, 95% confidence interval (CI):0.22-0.98), major bleeding (OR:0.25, 95% CI:0.07-0.80), and access site bleeding (OR:0.20, 95% CI:0.03-0.94). In the multivariable analysis, TRI was still significantly associated with a decrease in major bleeding events (OR:0.29, 95% CI:0.07-0.93). In conclusion, the use of TRI was associated with a reduction in bleeding events when referenced to TFI in the context of GV-PCI.

Characterization of radial artery perforation patterns using optical coherence tomography

BackgroundThe characterization of radial artery perforation (RAP) patterns using optical coherence tomography (OCT) has not been well established. This study aimed to identify the characteristic RAP patterns in patients diagnosed through post-procedural OCT examination. MethodsThis retrospective study included 1936 consecutive patients who underwent radial artery (RA) OCT following OCT-guided transradial coronary intervention (TRI) from January 2016 to July 2022. Data regarding RAP characteristics were collected through OCT, including the perforation site as well as dimensions such as the length, width, and arc. Furthermore, RAP types were classified as small or large perforations, with a cut-off arc value of ≤90°. ResultsRAP, as identified by RA angiography (RAA) during TRI and on post-procedural OCT, was found in 16 out of 1936 patients (0.83 %). RA OCT imaging showed that the median distance between the RA ostium and the perforation site, the perforation length, width, and arc were 30.6 (14.4–42.2) mm, 1.55 (1.03–1.92) mm, 0.74 (0.60–1.14) mm, and 42.5 (25.0–58.1) °, respectively. Small perforations (arc ≤90°) were observed in 14 out of the 16 (87.5 %) patients with RAP. Post-procedural RAA revealed that 15 out of the 16 (93.7 %) patients with RAP had sealed perforations, with the remaining patient requiring external compression. ConclusionsOur findings demonstrated that RAP is uncommon during TRI, with clearly defined characteristic patterns on OCT. Most RAPs are small and tend to spontaneous seal through catheter tamponade.

Chitosan‐Based Hemostatic Pad Reduced Vascular Complications After Transradial Coronary Intervention in Uncontrolled Hypertensive Patients: Application of Chitosan‐Based Hemostatic Pad on CAG or PCI

Background: Vascular complications after coronary angiography (CAG) or percutaneous coronary intervention (PCI) are a major concern for revascularization therapies. In this study, we investigated whether the application of a chitosan‐based hemostatic pad (HP) could ameliorate vascular complications after CAG or PCI procedures.Methods: We retrospectively analyzed patients undergoing CAG or PCI in our cardiovascular center from January 2019 to December 2021. The incidence of total vascular complications including errhysis, large hematoma, pseudoaneurysm, radial artery occlusion (RAO), blister, and pain was recorded. Subgroup analyses of patients with a history of hypertension, patients with uncontrolled hypertension, and patients with controlled hypertension were performed.Results: Our results demonstrated that the application of chitosan‐based HP had no effect on vascular complications after CAG or PCI procedures (odds ratio [OR]: 1.03 (0.84–1.26), p = 0.80). Nevertheless, chitosan‐based HP treatment markedly decreased the incidence of vascular complications in uncontrolled hypertensive patients (OR: 0.32 (0.11–0.95), p = 0.04), but not in hypertensive patients with controlled blood pressure (BP) (OR: 1.09 (0.88–1.35), p = 0.42).Conclusions: Chitosan‐based HP treatment could reduce the incidence of vascular complications in patients with uncontrolled hypertension. Nonetheless, applying chitosan‐based HP treatment after CAG or PCI procedures is not recommendable for controlled hypertensive patients.

Assessment of Vascular Dysfunction of Brachial and Radial Artery after Transradial Coronary Intervention by High Resolution Ultrasound and Flow Mediated Vasodilation

Assessment of Vascular Dysfunction of Brachial and Radial Artery after Transradial Coronary Intervention by High Resolution Ultrasound and Flow Mediated Vasodilation

Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study

Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Prospective active care combined with hydrogel dressing for the prevention of puncture site complications after transradial coronary intervention: A randomized controlled study

We evaluated whether the application of prospective active care (PAC) combined with hydrogel dressing during postoperative rehabilitation improved the prevention of puncture site complications after transradial coronary intervention (TRCI). In vitro, the hydrogel dressing exhibited good biocompatibility and did not reduce fibroblast activity and exhibited antimicrobial activity against Staphylococcus aureus and Streptococcus pneumoniae. In a cohort of patients with coronary artery disease who underwent with TRCI, the subjects were prospectively randomized into control and PAC groups, in which the control group was provided conventional care and the PAC group was provided PAC combined with the application of hydrogel dressing. The groups were compared for the rates of puncture site complications, recovery of finger function, cardiac function, and satisfaction. PAC combined with hydrogel dressing effectively reduced the incidence of complications. Furthermore, PAC combined with hydrogel dressing promoted the blood supply to the extremity used for TRCI and the recovery of mobile and cardiac functions and improved patient satisfaction with care. Therefore, the use of PAC combined with hydrogel dressings has great potential in patient care after TRCI and should be promoted in the clinic.

The Left Distal transradial access site could give a safe alternate site for transradial coronary intervention (The Litaunent Study).

Transradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.

Prevalence of Upper Extremity Function following Transradial Percutaneous Coronary Intervention

Background and Aim: The most frequently used technique for percutaneous coronary intervention (PCI) is the transradial approach (TRA). The purpose of the present study was to determine the prevalence of upper extremity function following transradial percutaneous coronary intervention. Patients and Methods: This cross-sectional study was conducted on 280 patients hospitalized for percutaneous coronary intervention in the Cardiology Department of MTI Lady Reading hospital, Peshawar and Lahore General Hospital from March 2022 to December 2022. Patients with palpable radial artery and non-occlusive flow confirmed by Doppler ultrasound examination were enrolled. Patients were divided into two groups: Group-I (underwent transradial approach (TRA)) and Group-II (treated with transfemoral PCI (TF-PCI). All the clinical outcomes were measured after 6 months follow-up. SPSS version 27 was used for data analysis. Results: Of the total 280 patients, the Group-I and Group-II had 220 and 60 patients respectively. During follow-up, the Group-I patients had higher incidence of upper extremity dysfunction (UED) (34.8%) than control or group-II patients (12.8%). Wrist extension, flexion, and elbow extension was the prime reasons for the upper extremity dysfunction. Smokers were three time at higher risk of developing upper extremity dysfunction. Conclusion: It has been observed that UED appears to occur twice as frequently in group-I as in group-II. Reduced rate of site complication and enhanced patient’s satisfaction has been found in group-I as compared to group-II. Keywords: Upper extremity function, percutaneous coronary intervention, transradial approach

Safety and efficacy of using Judkins left 3.5 guiding catheters for transradial right coronary artery intervention.

There is limited data about the use of a Judkins left (JL) 3.5 guiding catheter for routine transradial right coronary artery (RCA) percutaneous coronary intervention (PCI). This study investigated the safety and efficacy of JL3.5 for RCA PCI. Patients with acute coronary syndrome (ACS) who underwent transradial RCA PCI between November 2019 and November 2020 at the Second Hospital of Shandong University were included. The study retrospectively compared JL 3.5 vs. other routine guiding catheters (GCs), including Judkins right (JR) 4.0 and Amplatz (left). Logistic multivariable analysis was used to analyze the factors associated with transradial RCA PCI success rate, in-hospital complications, and extra support. The study included 311 patients: 136 in the routine GC group and 175 in the JL 3.5 group. There were no significant differences between the two groups regarding in-hospital complications, extra support technics, or success. The multivariable analyses showed that coronary chronic total occlusion (CTO) was negatively associated with intervention success (OR = 0.06, 95% CI: 0.016-0.248, p < 0.001) but positively with extra support (OR = 8.74, 95% CI: 1.518-50.293, p = 0.015). Tortuosity was associated with extra support (OR = 16.50, 95% CI: 3.324-81.589, p = 0.001). In the JL 3.5 group, the left ventricular ejection fraction (OR = 1.11, 95% CI: 1.03-1.20, p = 0.006), CTO (OR = 0.07, 95% CI: 0.008-0.515, p = 0.009), and tortuosity (OR = 0.17, 95% CI: 0.03-0.95, p = 0.043) were independently associated with intervention success. JL 3.5 appears to be as safe and effective as the JR 4.0 and Amplatz (left) catheters for RCA PCI. When using the JL 3.5 catheter for RCA PCI, heart function, CTO, and tortuosity should be considered.

Do We Still Need to Assess Post-procedural Radial Artery Compression Time and Radial Artery Occlusion in Patients Who Undergo Transradial Coronary Intervention?

Background and objective Transradial access (TRA) for interventional coronary procedures has now been widely accepted as the preferred vascular site approach. The duration of post-procedure compression has been shown to be a crucial factor and different hemostatic devices used in this regard have been compared. In this study, we aimed to compare the post-procedure compression time, radial artery occlusion (RAO), hematoma, and bleeding between the transradial (TR) band and AIR band for radial artery patency among patients presenting at a tertiary care hospital. Methodology This observational study was conducted at the Department of Cardiology of Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre, Awali, Bahrainfrom 06/03/2022 to 05/06/2022. The research involved patients of either gender who had a positive Barbeau test (type A to C) and were receiving percutaneous coronary intervention via a transradial route. Patients who underwent transradial coronary intervention were classified into two separate groups, depending on whether an AIR band (group A) or a TR band (group B) compressionwas used. Following coronary catheterization, radial hemostatic compression devices were used. The results were documented both during and after the hemostatic compression. The data were analyzed using IBM SPSS Statistics version 23 (IBM Corp., Armonk, NY). Results Of the total 100 patients included in the study, the majority weremales (86%) and aged more than 50 years (83%). AIR band was successfully removed in 32 patients (64%) in less than four hours, compared to the TR band, which was removed in less than four hours in two patients (4%) only (p=0.001). The incidences of bleeding (p=0.790) and RAO (p=0.495) were similar between the AIR band group and the TR band group. Hematoma was not seen in any of the patients in either group. Conclusion AIR band was observed to be more efficacious in decreasing the radial artery compression time. However, the difference in RAO was insignificant in the short term, andfollow-up studies are required to see if the AIR band is associated with any long-term benefits.

Radial artery pseudoaneurysm following transradial percutaneous coronary intervention

Radial artery pseudoaneurysm following transradial percutaneous coronary intervention

Upper Extremity Function Following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trail

Background: Regardless of the recent rise in the number of articles published on transradial access (TRA) for diagnostic coronary intervention and complications of the upper extremity may be underestimated. The aim of this study to investigate the prevalence of upper extremity disorder by comparing the transradial and transfemoral artery percutaneous coronary intervention (TR-PCI). Study Design: This was cross-sectional study and conducted in the Ayub teaching hospital Abbotabad, for six months July 2022 to December 2022. Materials and Methods: The total participants were 250 which included 200 TRA and 50 TFA participants and involving any type of cerdiointervention, thrombectomies for acute ischemic stroke, and carotid artery stents. The participants were selected by sampling technique were interviewed in the Khyber teaching hospital Peshawar. We analyzed dependent and independent variables. Data analysis statistically by SPSS 22 version. The upper extremity scores were analyzed using Chi-squared test. Results: There were total 250 participants which include 80%TRA and 20% TFA in this research. The majority of the participants in TRA were in the age group (59.2±6.7) years and in TFA group (55.5±7.1) years. The baseline characteristics of the total participants was no significant difference between transradial artery (TRA) and transradial femoral artery (TFA). During follow-up, Cochran's Q-test revealed a significant increase in UED in the intervention extremity of the TRA group p=0.003 and in the TFA group's right upper extremity (p=0.001). During follow-up, 1% TRA participants had RAO, which recanalized over time. Three weeks after the procedure, 10% of participants in the TRA group were referred to a hand specialist then TFA participants. Conclusion: Transradial arterial access (TRA) for percutaneous coronary artery intervention has been linked to lower access site complication rates and higher patient satisfaction when compared to transfemoral access (TFA) after 3 weeks follow up. Keywords: Transradial artery (TRA), Transfemoral artery (TFA), Rotational acetabular osteotomy (RAO).

Frequency of radial artery occlusion in patients with diabetes mellitus 24.hr and one month after coronary intervention

Introduction: Transradial coronary intervention (CI) is frequently complicated by radial artery occlusion (RAO). The research has a variety of prevalence reports, and its indicators are not properly known. The purpose of this research was to analyze the frequency of RAO in diabetes mellitus patients 24 hours and one-month following CI. Methods: In this study, 1,350 participants (included 101 repeated operations after one month) who undergo 1,451 CI, were involved. Participants were assessed for RAO 24 hours and one month following CI. The major result was not identified in 47 participants (3.2%), thus, data on 1,303 participants were provided for analysis of the data. After receiving CI for 24 hours and a month, individuals with diabetic mellitus (DM) had their predictors of RAO examined using multiple regression analysis. Results: The total participants of 1,303 included 1,018 (78.1%) men and 285 (21.6%) women, with an average age of 57.6 years. The major result was not identified in 47 participants (3.2%), thus, data on 1,256 participants were provided for analysis of the data, in which 149 participants (12.3%) had the primary outcomes. There were 46 women (30.2%) in the RAO group. In the RAO cohort, DM was found in 58 (39.5%) individuals.

Combination Therapy With Nicardipine and Isosorbide Dinitrate to Prevent Spasm in Transradial Percutaneous Coronary Intervention (from the NISTRA Multicenter Double-Blind Randomized Controlled Trial)

Verapamil and nitroglycerin are widely used to prevent radial artery spasm (RAS) during percutaneous cardiovascular procedures. However, these agents are not typically available in most African countries and consequently, isosorbide dinitrate is often the only spasmolytic treatment. Our aim was to compare the efficacy of isosorbide dinitrate alone versus isosorbide dinitrate used together with nicardipine to prevent RAS during transradial coronary procedures. This was a randomized controlled double-blind multicenter trial. Patients (n=1,523) were randomized to receive either a sole therapy of isosorbide dinitrate (n=760) or the combination of isosorbide dinitrate and nicardipine (n=763). Our primary end point was the occurrence of RAS; defined as considerable perceived hindrance of catheter advancement. Our secondary end points were severe RAS; defined as (1) severe arm pain, (2) the need for either morphine or midazolam treatment, and (3) necessity for crossover to the contralateral radial or femoral artery. RAS incidence was reduced with the combination therapy versus isosorbide dinitrate alone (15% vs 25%, p <0.001), with a number needed to treat of 10 patients. There was also a significant reduction in the incidence of the secondary end points with combination therapy (3.6% vs 8.2%, p <0.001), with a number needed to treat of 22 patients. This result was driven by reductions in both femoral crossover (0.5% vs 2.4%, p=0.003) and the use of morphine or midazolam injections (1.6% vs 3.5%, p=0.02) with combination therapy. In conclusion, we demonstrated the superiority of the combination therapy of isosorbide dinitrate and nicardipine over isosorbide dinitrate alone in reducing the incidence of RAS.

Subclavian angioplasty during coronary interventions using radial approach.

In the past years, the percentage of percutaneous coronary angiography and coronary interventions using radial access had significantly increased due to its higher safety, lower risk of major bleeding, and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion. To evaluate the feasibility and safety of performing subclavian angioplasty via radial access during complex coronary interventions using the forearm approach. A series of patients with complex radial approach due to subclavian stenosis received subclavian angioplasty during the procedure. We included 48 patients out of 22 500 procedures performed from February 2009 to February 2020. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion, which makes femoral access crossover difficult; also the contralateral radial/ulnar artery was very faint or not detectable at all). Mean age was 72 (10) years and 67% of patients were males. Subclavian angioplasty was successfully done in all patients via ipsilateral radial access; 44 patients (91.7%) required subclavian stenting, and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly achieved through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated. It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach.

Effect of Thin-Walled Radial Sheath for Large-Bore Access On Reducing Periprocedural Radial Artery Occlusion Following Complex PCI: The REDUCE-RAO Randomized Trial.

Transradial artery (TRA) access for percutaneous coronary intervention (PCI) was associated with lower risks of major bleeding and vascular complications compared to transfemoral artery access. Use of large-bore ( 7-Fr) guiding catheters through TRA approach increased the likelihood of radial artery occlusion (RAO). This study aimed to investigate whether use of the thin-walled 7-Fr Glidesheath Slender, allowing PCI with large-caliber guiding catheters, is superior to standard 7-Fr Cordis sheath with respect to periprocedural RAO within 24 hours after transradial coronary intervention (TRI) in complex lesions. A prospective randomized, controlled, single-blinded (patient-blinded) trial was conducted, randomizing 504 patients with TRI for complex lesions to either 7-Fr Glidesheath Slender or conventional 7-Fr Cordis sheath. The primary outcome was defined as the incidence of periprocedural RAO with Doppler ultrasound during the first 24 hours after TRI. The incidence of early RAO was 10.3% for 7-Fr Glidesheath Slender and 13.5% for conventional 7-Fr sheath (p = 0.271). The procedural success rate for Glidesheath Slender was 92.9% and for Cordis sheath was 93.7% (p = 0.722). There was no signficiant difference between treatment arms in terms of local hematoma and radial spasm, whereas use of the Glidesheath Slender was associated with significantly less pain during the procedure (numeric rating scale [NRS], 2.27 0.75 vs. 2.45 0.95, p = 0.017). The assessment of radial artery in ultrasound parameters after complex TRI was improved with Glidesheath Slender. Among patients with complex coronary lesions undergoing TRI, 7-Fr Glidesheath Slender was not superior to conventional 7-Fr in the prevention of periprocedural RAO within 24 hours following complex PCI, without reducing RAO occurrence. NCT04748068.

Upper Extremity Function following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trial.

Objectives To determine the incidence of upper extremity dysfunction (UED), after a transradial percutaneous coronary intervention (TR-PCI). Background Transradial approach (TRA) is the preferred approach for coronary interventions. However, upper extremity complications may be underreported. Methods The ARCUS was designed as a prospective cohort study, including 502 consecutive patients admitted for PCI. Patients treated with transfemoral PCI (TF-PCI) acted as a control group. A composite score of physical examinations and questionnaires was used for determining UED. Clinical outcomes were monitored during six months of follow-up, with its primary endpoint at two weeks. Results A total of 440 TR-PCI and 62 control patients were included. Complete case analysis (n = 330) at 2 weeks of follow-up showed that UED in the TR-PCI group was significantly higher than that in the TF-PCI group: 32.7% versus 13.9%, respectively (p=0.04). The three impaired variables most contributing to UED were impaired elbow extension, wrist flexion, and extension. Multivariate logistic regression showed that smokers were almost three times more likely to develop UED. Conclusions This study demonstrates that UED seems to occur two times more in TR-PCI than in TF-PCI at 2 weeks of follow-up. However, no significant long-term difference or difference between the intervention arm and the contralateral arm was found at all timepoints.

A randomized trial of flow-mediated dilation to prevent radial artery spasm during transradial approach.

Although transradial approach has been increasingly preferred for percutaneous coronary interventions, radial artery spasm (RAS) is still one of the major disadvantages. Flow-mediated dilation (FMD) is a well-known method for assessing endothelial function through dilation. The aim of this study was to investigate the efficacy of prepuncture flow mediated dilation in preventing RAS during transradial approach. The present study prospectively included 222 consecutive patients who underwent transradial coronary intervention. Patients were 1:1 randomized into two groups who underwent prepuncture FMD and who did not (FMD [+] and FMD [-], respectively). In FMD [+] group the incidence of RAS was lower (5.4% vs. 16.2%, P=0.009). Multivariate logistic regression analysis demonstrated that female sex, more than two catheter usage and transradial approach without prepuncture FMD independently predicted RAS (odds ratio [OR]=4.66, 95% confidence interval [CI]: 1.8-12.06, P=0.001, OR=5.73, 95% CI: 2.01-16.39, P=0.001, and OR=5.01, 95% CI: 1.74-14.48, P=0.003; respectively). However, access site crossover number was very low in both groups and not different between groups. Prepuncture FMD can significantly reduce RAS during transradial coronary interventions. Thus, prepuncture FMD can be used as a simple adjunctive method to prevent RAS.