Transradial Coronary Procedures Research Articles

Comparison of characteristics during transradial and transfemoral coronary procedures – initial experience from University Hospital Merkur

Comparison of characteristics during transradial and transfemoral coronary procedures – initial experience from University Hospital Merkur

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6-15 months following the intervention. RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 ± 9.7 vs. 59.1 ± 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8%) was lower (p < 0.001) than the observed incidence (23%) in non-hypertensive patients. RAO group had higher rate (28%, p = 0.027) of post--procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. The present study reveals that the long-term incidence of RAO is 16.4%. Hypertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term.

Radial access during percutaneous interventions in patients with acute coronary syndromes: should we routinely monitor radial artery patency by ultrasonography promptly after the procedure and in long-term observation?

Access-site vascular complications in patients undergoing transradial coronary procedures are rare but may have relevant clinical consequences. The aim of the study was to evaluate: (1) radial artery’s (RA) patency immediately after the procedure and in long-term observation, (2) factors influencing the frequency of radial artery’s occlusion (RAO) after percutaneous coronary intervention (PCI) procedures performed via transradial access in the group of 220 patients with acute coronary syndromes (ACS). RA ultrasound was performed 48–72 h after the procedure and in those who were diagnosed with RAO-again after 6–12 months. According to the ultrasonographic findings, the patients were divided into two sub-groups: 187 pts (85 %) with patent RA after PCI and 33 pts (15 %) with RAO. Both sub-groups significantly statistically differed with regard to the frequency of local hematomas—15 versus 27.3 % (p = 0.02), the frequency of applying IIbIIIa inhibitors in PCI—6.4 versus 15.1 % (p = 0.015) and procedure duration—0.59 ± 0.37 versus 0.77 ± 0.38 (p = 0.014), respectively. In a multifactorial analysis the only factor influencing RA patency promptly after the procedure was PCI duration (p < 0.05, r = −0.22). In the follow-up, right RA remained still obstructed in 28 patients (12.7 %) whereas in five patients (2.3 %) the regular flow in RA was resumed. The chronic RAO was clinically silent. Due to insignificant frequency of the occurrence of RAO after PCI procedure in patients with ACS as well as practically lack of clinical consequences of this artery’s occlusion in long-term observation, we do not see any implications to routine ultrasound periprocedural RA evaluation.

Low plasma renin level is associated with the occurrence of angiographic radial artery spasm in patients undergoing transradial coronary procedures

Transradial coronary angiography and intervention have become increasingly popular due to lower vascular complications rates, high procedural success, and early patient mobilization when compared with the femoral approach [1]. Radial artery spasm (RAS) is the most commonly encountered complication resulting in significant discomfort to patients and procedural failure [2]. The clinical factors affecting the prevalence of RAS include female gender, age and diabetes mellitus, radial artery anomaly and diameter [3].

Need for prophylactic application of verapamil in transradial coronary procedures: a randomized trial. The VITRIOL (is Verapamil In TransRadial Interventions OmittabLe?) trial.

BackgroundVerapamil is traditionally applied prophylactically in transradial procedures to prevent radial artery spasm. However, verapamil may have side effects and is contraindicated in some clinical settings.Methods and ResultsDuring an investigator‐initiated, randomized, double‐blind trial, we evaluated the need for preventive verapamil administration. After vascular access was established, patients received either 5 mg verapamil (n=297) or placebo (n=294). We compared the rate of access site conversions as primary end point using a superiority margin of 5%. Occurrence of code breaks (composite of conversions and unplanned use of verapamil), overall verapamil use, procedural and fluoroscopic times, contrast volume, and subjective pain were investigated as secondary end points. The rate of access site conversions was not different in the 2 arms (placebo 1.7% versus verapamil 0.7%, P=0.28, difference 1.0%, 95% CI for the difference −1.1% to 3.3%). Proportion of code breaks was similar in the 2 groups (3.4% versus 1.3%, P=0.11), whereas overall verapamil use was markedly lower in the placebo arm (2.0% versus 100%, P<0.0001). Procedural time (median [IQR] 16.0 minutes [9.0 to 30.0 minutes] versus 17.0 minutes [10.0 to 31.0 minutes], P=0.37), fluoroscopic time (4.4 minutes [2.1 to 9.6 minutes] versus 4.8 minutes [2.4 to 10.7 minutes], P=0.28), contrast volume (72.5 mL [48.0 to 146.0 mL] versus 75.5 mL [47.0 to 156.5 mL], P=0.74), and pain score (P for trend=0.12) were comparable in the 2 groups.ConclusionsThe preventive use of verapamil may be unnecessary for transradial procedures. The omission of prophylactic verapamil may not only reduce the rate of potential complications related to the drug but also allow the safe extension of the transradial method to those with contraindications to verapamil.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01402427.

Feasibility and safety of a virtual 3‐Fr sheathless‐guiding system for percutaneous coronary intervention

To evaluate the feasibility and safety of a virtual 3-Fr system [5-Fr sheathless-guiding catheter (GC)] for percutaneous coronary intervention (PCI). The use of miniaturized devices for PCI is gaining popularity because of increased patient comfort and decreased risk of access site complications. From July 2010 to December 2012, consecutive patients who underwent elective PCI (planned or ad hoc PCI) at our hospital were enrolled. PCI using the virtual 3-Fr system was attempted as our initial strategy, unless a 6-Fr or larger GC was considered to be suitable [lesions with heavy calcification, large (>2 mm) side branches, or chronic total occlusion]. Five hundred sixty-six patients underwent elective PCI during the study period, and 132 patients who met the criteria underwent PCI using the virtual 3-Fr system. Procedures using the virtual 3-Fr system were successful in 126 patients (95%); 111 (84%) were performed using the transradial approach, 110 (83%) were ad hoc procedures, and 45 (31%) were complex coronary lesions (type B2 or C). Six patients required conversion to a conventional 5- or 6-Fr sheath and catheter system. No intraoperative complications occurred, and radial artery patency was achieved in all patients who underwent transradial procedures. PCI using the virtual 3-Fr system is a feasible and viable alternative to conventional procedures that use a sheath and GC in appropriately selected patients. This small-caliber system may minimize endovascular trauma, particularly during transradial coronary procedures.

Transradial approach in the diagnosis and treatment of coronary artery disease: a 2-center experience.

To document the safety, success, and complications of transradial coronary procedures. This retrospective study consisted of 427 patients who had undergone transradial coronary angiography and/or angioplasty between June 2010 and May 2012. The main outcome measures were the procedural safety, success rate, and complications associated with transradial interventions. Procedural success rate was 93.2% (398/427), with cannulation time of 2.1 ± 1.4 min, diagnostic time of 5.6 ± 2.1 min, fluoroscopy time of 9.5 ± 6.6 min, and total procedure time of 47.1 ± 20.2 min. The main causes for unsuccessful procedures were failed radial puncture (11 patients), serious radial artery spasm (12 patients), and distinct tortuosity (5 patients) and severe proximal stenosis (1 patient) of the right subclavian artery. Of 398 patients, 345 (86.7%) underwent both coronary angiography and angioplasty, while the remaining 53 (13.3%) had coronary angiography only. Major complication was recorded in only 1 patient (transient ischemic attack), whereas minor complications were observed in 76 patients (17 with symptomatic sinus bradycardia, 12 with venous thrombosis, 22 with hematoma, and 25 with radial artery occlusion). Our experience revealed that the transradial approach is a safe and feasible method for coronary procedures in patients with various manifestations of coronary disease.

Radial artery complications occurring after transradial coronary procedures using long hydrophilic-coated introducer sheath: a frequency domain-optical coherence tomography study

This study was performed to analyze the impact of transradial intervention (TRI), performed by long (25-cm) hydrophilic-coated radial introducer sheath (HRS), on radial artery (RA). Both acute damages and chronic intimal modifications, occurring in RA, were assessed using frequency domain-optical coherence tomography (FD-OCT). FD-OCT evaluation of RA was performed in 51 consecutive patients, undergoing TRI by long (25-cm) HRS. FD-OCT was performed from RA ostium to the puncture site. Acute damages such as intimal tears and medial dissections together with chronic intimal modifications, assessed as intimal hyperplasia indexes, were observed and compared between proximal and distal RA segments. Intimal tears were detected in 37% of patients, especially located in proximal RA segment (p = 0.09). Medial dissections were imaged in 9.8% of patients with no significant difference between proximal and distal RA segments. Intimal hyperplasia indexes were higher in distal RA segment, with no significant association with a previous history of TRI. In the setting of TRI, performed by long HRS, intimal tears represented the main RA injury occurring in about one-third of patients, while medial dissections only occurred in a small proportion of patients. Distal RA segment was more prone to intimal thickening, although this phenomenon was not associated with repeated transradial procedures.

The Long Term Incidence and Predictors of Radial Artery Occlusion Following a Transradial Coronary Procedure

OP-008 Our aim was to establish the long term incidence of radial artery occlusion and investigate its predictors. Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there are no studies reporting the incidence and predictors of

A novel lead attenuator to reduce operator exposure to scattered radiation in transradial coronary procedures

A novel lead attenuator to reduce operator exposure to scattered radiation in transradial coronary procedures

TCT-291 Randomized Comparison of Low (2500 IU) versus Standard (5000 IU) Heparin Dose for Prevention of Forearm Artery Occlusion after Coronary Angiography

Radial artery occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Higher over lower levels of systemic anticoagulation are believed to reduce RAO rates but this is ill-supported by scientific evidence. This was a prospective, randomized, single-center study of parallel

The Long Term Incidence and Predictors of Radial Artery Occlusion Following a Transradial Coronary Procedure

Our aim was to establish the long term incidence of radial artery occlusion and investigate its predictors.

Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention

Background More and more percutaneous coronary intervention were done from radial artery approach. But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach. The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention. Methods A total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled. Radial arteriography was performed in all patients to detect the anatomical variations of this vessel. All patients' radial and ulnar artery inner diameters were measured using a computer assisted quantification method. A detailed patient history was recorded. Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables (including age, gender, ethnicity, height, weight, body mass index, smoking, diabetes, hypertension and dyslipidemia) in arterial tortuosities and variations of this vessel. Results In southern Chinese populations, there were no significant differences in the diameters of the forearm arteries: the mean radial artery inner diameter was (3.04±0.43) mm in ethnic Han Chinese and (3.05±0.42) mm in ethnic Zhuang Chinese, P &gt;0.05), the mean ulnar artery inner diameter was (3.03±0.38) mm in Han Chinese and (3.05±0.36) mm in Zhuang Chinese, P &gt;0.05). It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients, and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients. The factors found to positively affect the size of the radial artery were sex (b j=0.309, P &lt;0.01), weight (b j=0.103, P &lt;0.01), and diabetes mellitus (b j= -0.088, P &lt;0.01) was found to negatively affect radial artery size. Arterial tortuosities occurred in 12.1% of patients and arterial variations in 4.1%. The incidence of tortuosities and variations included radial artery tortuosity (3.6%), high origin of radial artery (1.7%), radial artery loop (0.6%), double radial artery (0.1%), brachial artery tortuosity (0.4%), double brachial artery (0.1%), subclavian artery tortuosity (5.4%), small subclavian artery (0.4%), right retro-esophageal subclavian artery (0.6%), brachiocephalic trunk tortuosity (2.8%), small brachiocephalic artery (0.1%), and brachiocephalic artery anomaly (0.4%). For people in Guangxi province, tortuosities of the subclavian artery and radial artery are the most common among the vascular tortuosities of the radial artery approach. The overall rate of transradial procedural success was 96.1%. Procedural failure was more common in patients with anomalous radial artery approach than in patients with normal radial artery approach (22.8% vs. 1.8%, P=0.000). According to multivariate Logistic regression analysis, age (OR=2.695, 95% CI 2.232-3.253, P=0.000), female gender (OR=5.127, 95% CI 3.000-8.762, P=0.000), height (OR=0.612, 95% CI 0.465-0.807, P=0.000), body mass index (OR=2.377, 95% CI 1.834-3.082, P=0.000), hypertension (OR=1.668, 95% CI 1.132-2.458, P=0.010), hyperlipidemia (OR=1.273, 95% CI 1.425-2.049, P=0.034) and smoking (OR=5.750, 95% CI 3.636-9.093, P=0.000), were independently associated with arterial tortuosities of the radial artery approach. Female gender was independently associated with arterial variations of the radial artery approach (OR=3.613, 95% CI 3.208-7.826, P=0.000). Conclusions The diameters of the radial and ulnar arteries between the Han people and the Zhuang people in southern Chinese populations are similar. In a transradial operation, the most southern Chinese populations, the use of a 6F sheath and guiding catheter is safe, and using a 7F sheath and guiding catheter is feasible in some selected patients. Radial arterial tortuosities and variations in southern Chinese populations are relatively common and are a significant cause of the failure of transradial coronary procedure. Old age, female gender, short stature, high body mass index, hypertension, hyperlipidemia and smoking, were independently associated with an increased risk of arterial tortuosity. In addition, female gender was an independent predictor of arterial variations.

Impact of Transradial Coronary Procedures on Radial Artery Function

We evaluated the impact of transradial coronary procedures on the vasodilatory function of the radial artery. A total of 65 patients who underwent transradial coronary procedures were enrolled. All patients were examined with B-mode high-resolution ultrasound. Radial artery baseline diameter and response to flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) were measured in the right radial artery. The FMD of the right radial artery was 11.5%, 4.1%, and 0.7%, respectively, before the procedures, 1 day, and 3 months after the procedures (P < .05 at 1 day, P < .01 at 3 months). The NMD of the right radial artery was 17.6%, 5.4%, and 6.3%, respectively, before the procedures, 1 day, and 3 months after the procedures (P < .05 at 1 day, P < .05 at 3 months). Transradial coronary procedures decrease radial artery FMD and NMD resulting in immediate and persistent blunting of vasodilatory function.

Feasibility and utility of pre‐procedure ultrasound imaging of the arm to facilitate transradial coronary diagnostic and interventional procedures (PRIMAFACIE‐TRI)

To assess feasibility and utility of imaging of both arms using ultrasound to facilitate transradial (TR) and transulnar (TU) coronary angiograms (CA) and intervention. Despite well recognized advantages, transradial approach (TRA) has challenges that reduce procedural success including small arterial size, anatomical variations, and anomalies of radial artery (RA). The utility of routine pre-procedural ultrasound of the arm arteries (PPUAA) in facilitating TRA has not been previously studied. To determine the role of PPUAA, we performed a single center registry of consecutive patients undergoing diagnostic and interventional procedures between 2006 and 2011. All patients underwent PPUAA of the right and left radial, ulnar (UA), as well as the brachial arteries (BA) in the antecubital fossa using a linear probe. End-points assessed included the incidence and correlates of arterial sizes, vascular anomalies, procedure success, and fluoroscopy as well as ultrasound assessment times. RA occlusion rates were studied in the last 10 months of the study period. Complete data on radial (mean 1.9 mm (male);1.7 mm (female)) and ulnar artery size (mean 1.8 mm (male); 1.6 mm (female)) and data on brachial branching anatomy were available in 2,344 patients; 1,872 of whom underwent a TR or TU procedure. The mean time to perform bilateral PPUAA was 6.4 min ± 1.8 min. The incidence of arterial abnormalities was 9.8% in PPUAA. Procedure success was 98.7% for CA and 97.5% for percutaneous coronary intervention. Outcomes were better in this cohort compared with remaining 3,781 patients in whom PPUAA data were not available. This single center prospective registry shows that PPUAA is feasible, requires minimum time, and provides anatomical information that may improve procedure success while reducing patient discomfort, arterial spasm, and fluoroscopy time. These findings should be confirmed in a randomized trial.

Access site complications and puncture site pain following transradial coronary procedures: A correlational study

BackgroundTransradial coronary angiography (CA) and percutaneous coronary intervention (PCI) are gaining worldwide popularity due to the low incidence of major vascular complications and early mobilization of patients post procedures. Although post transradial access site complications are generally considered as minor in nature, they are not being routinely recorded in clinical settings. ObjectivesTo evaluate the incidence of access site complications and level of puncture site pain experienced by patients undergoing transradial coronary procedures and to examine factors associated with access site complications occurrence and puncture site pain severity. MethodsA cross-sectional correlational study of 85 Chinese speaking adult patients scheduled for elective transradial CA and or PCI. Ecchymosis, bleeding, hematoma and radial artery occlusion (RAO) were assessed through observation, palpation and plethysmographic signal of pulse oximetry after coronary procedures. Puncture site pain was assessed with a 100mm Visual Analogue Scale. Factors that were related to access site complications and puncture site pain were obtained from medical records. ResultsEcchymosis was the most commonly reported transradial access site complication in this study. Paired t-test showed that the level of puncture site pain at 24h was significantly (p<0.001) lower than that at 3h after the procedure.Stepwise multivariable regression showed that female gender and shorter sheath time were found to be significantly associated with bleeding during gradual deflation of compression device. Only longer sheath time was significantly associated with RAO. Female gender and larger volume of compression air were associated with the presence of ecchymosis and puncture site pain at 3h after procedure, respectively. ConclusionsThe study findings suggest that common access site complications post transradial coronary procedures among Chinese population are relatively minor in nature. Individual puncture site pain assessment during the period of hemostasis is important.Nurses should pay more attention to factors such as female gender, sheath time and volume of compression that are more likely to be associated with transradial access site complications and puncture site pain.

Incidence and Predictors of Radial Artery Spasm at the Beginning of a Transradial Coronary Procedure

Our aim was to establish the frequency of radial artery spasm (RAS) and its predictors at the beginning of a transradial approach (TRA). This was a single-center prospective study. A total of 1,722 consecutive patients undergoing their first transradial coronary procedure were recruited. After radial artery puncture, a hydrophilic sheath was used to complete arterial puncture, then 500 μg glycerol trinitrate and 2.5 mg verapamil were injected into radial artery along the sheath. After retrograde radial arteriography spasm was defined angiographically as a stenosis greater than 25%. Patient demographics, procedural data such as total procedural duration, the number of catheters and guidewires used, the amount of contrast media usage, dose area product (DAP) and fluoroscopy time, and vascular complications were recorded. The overall spasm incidence was 10.3%. The procedural success rate was lower in patients with spasm than in patients without spasm (80% vs. 95.7%, P < 0.001). The patients with spasm were older (mean age 63.9 ± 9.4 years vs. 60.0 ± 11.2 years, P < 0.001) and more commonly female (51.3% vs. 34.4%, P < 0.001). Spasm was more common in hypertensive patients (66% vs. 56%, P < 0.009). Surprisingly, smoking was less common in patients with spasm (17% vs. 29%, P < 0.001). Multiple logistic regression analysis showed that female gender (OR = 1,524, 95% CI: 1.033-2.248, P = 0.034) was the only independent predictor of RAS at the beginning of the procedure. The incidence of RAS was 10,3%, and female gender was the sole independent predictor of RAS at the very beginning of the procedure in patients undergoing a TRA.

Impact of a dedicated “radial lounge” for percutaneous coronary procedures on same-day discharge rates and bed utilization

Two advantages of transradial coronary procedures are an increased potential for same-day discharge and better resource management. This study assessed the impact of a dedicated "radial lounge" (1) on the rate of same-day discharge after elective percutaneous coronary intervention (PCI) and coronary angiography and (2) on bed utilization. We compared our unit's rates of same-day discharge in patients who underwent elective PCI or coronary angiography in the year before and in the year after the opening of a dedicated radial lounge for elective patients. In its first year of operation, 439 patients who underwent PCI and 1,109 patients who underwent angiography were managed in the radial lounge. Among these patients, the rate of same-day discharge was 84.7% after PCI and 97.0% after angiography. Requirement for overnight admission was significantly more common after femoral access compared with radial access for both angiography (4.1% vs 2.8%, P < .05) and PCI (20.3% vs 14.2%, P < .01). The unit's overall rate of same-day discharge increased from 2.3% to 51.2% after elective PCI (P < .0005) and from 72.7% to 84.9% after elective angiography (P < .005). An estimated 595 bed days were saved through reduced overnight admissions in elective patients. Our unit's overall rates of same-day discharge after elective PCI and coronary angiography increased dramatically in the year after the opening of a dedicated radial lounge. This was directly attributable to the high rates of same-day discharge in radial lounge patients. The radial lounge impacted favorably on in-patient bed capacity.

ASSESSMENT OF EARLY RADIAL INJURY AFTER TRANSRADIAL CORONARY INTERVENTION BY HIGH-RESOLUTION ULTRASOUND BIOMICROSCOPY

ObjectivesThe radial artery has become an alternative vascular access site for percutaneous coronary procedures. Transradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial...

TCT-396 Assessment of early radial injury after transradial coronary intervention by high-resolution ultrasound biomicroscopy: Innovative technology application

The radial artery has become an alternative vascular access site for percutaneous coronary procedures. Transradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial coronary procedure and the quality as a bypass conduit. We sought to compare