Transradial Group Research Articles

Comparison Between Transradial and Transfemoral Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction

Transradial (TR) access is increasingly being used in percutaneous coronary intervention (PCI). However, its role in PCI for ST-segment elevation myocardial infarction remains controversial because of concerns of procedural complexity adversely affecting the promptness of reperfusion. In this study, 150 consecutive patients who underwent PCI for acute ST-segment elevation myocardial infarction over a period of 24 months were prospectively evaluated; 46 had TR access (31%) and 104 (69%) had transfemoral (TF) access. All patients received thienopyridines, aspirin, and heparin per routine management. There were no significant differences between the TR access and TF access groups with respect to age (62.2 ± 11.6 vs 64.7 ± 14.1, p = 0.28), gender (76.1% vs 72.1% men, p = 0.69), or incidence of diabetes (23.9% vs 26.9%, p = 0.84). The TR and TF access groups were comparable with respect to door-to-balloon time (79.2 ± 32.3 vs 86.8 ± 51.8 minutes, p = 0.67) and amount of contrast used (190.5 ± 101.5 vs 172.2 ± 81.7 ml, p = 0.24). Total fluoroscopy time was longer in the TR access group compared to the TF access group (21.7 ± 12.7 vs 14.4 ± 10.4 minutes, p <0.0001). Postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow was comparable for the 2 groups (87% for the TF group and 96% for the TR group, p = 0.15). There were no vascular complications in the TR access group compared to the TF access group (0% vs 5.8%, p = 0.18). In conclusion, this single-center observational study shows that TR access for PCI in STEMI is feasible and that it has fewer vascular complications and shorter length of hospital stay than the TF approach.

Two different surgical pathways for urgent percutaneous coronary intervention

Objective To compare the advantages and disadvantages in urgent percutaneous coronary intervention ( PCI ) with transradial or transfemoral approach,and to explore the feasibility of urgent PCI with transradial approach in primary hospitals.Methods 90 patients with acute myocardial infarction who needed interventional therapy were divided into transradial approach group ( n =45 ) and transfemoral approach group ( n =45 ).Time to balloon opening after medical visit,success rate of the procedures,incidence rate of complications,duration of X-ray exposure,and length of hospital day were compared between the two groups.Results The success rate of the procedures,time to balloon opening after medical visit,and duration of X-ray exposure did not differ significantly between the two group ( P ＞ 0.05 for all comparisons ).Length of hospital day were shortened and rate of complications were lowered in the transradial procedure group ( P ＜ 0.01 and P ＜ 0.05 ).Conclusions Urgent percutaneous coronary intervention with transradial approach has a higher success rate and fewer complications,can relieve the pain level in patients,and is suitable to apply in primary hospital.But the prerequisite is accumulation of large amount of experience on transfemoral coronary intervention and transradial coronary angiography. Key words: Acute myocardial infarction; Coronary intervention therapy; Radial artery; Femoral artery; Primary hospitals

Transradial Percutaneous Coronary Intervention for Acute Myocardial Infarction Reduces CCU Stay in Patients 80 or Older

Transradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 ± 1.5 days and 5.0 ± 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 ± 7.4 days and 19.2 ± 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 ± 0.7 and 4.6 ± 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (≤ 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients ≥ 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population.

Transradial Versus Transfemoral Intervention for Acute Myocardial Infarction: A Propensity Score-Adjusted and -Matched Analysis From the REAL (REgistro regionale AngiopLastiche dell'Emilia-Romagna) Multicenter Registry

This study sought to assess whether transradial intervention, by minimizing access-site bleeding and vascular events, improves outcomes in patients with ST-segment elevation myocardial infarction compared with the transfemoral approach. Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty. We identified all adults undergoing percutaneous intervention for acute myocardial infarction in Emilia-Romagna, a region in the north of Italy of 4 million residents, between January 1, 2003, and July 30, 2009, at 12 referral hospitals using a region-mandated database of percutaneous coronary intervention procedures. Differences in the risk of death at 2 years between patients undergoing transfemoral versus transradial intervention, assessed on an intention-to-treat basis, were determined from vital statistics records and compared based on propensity score adjustment and matching. A total of 11,068 patients were treated for acute myocardial infarction (8,000 via transfemoral and 3,068 via transradial route). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for the transradial than for the transfemoral group (8.8% vs. 11.4%; p = 0.0250). The rate of vascular complications requiring surgery or need for blood transfusion were also significantly decreased in the transradial group (1.1% vs. 2.5%, p = 0.0052). In patients undergoing angioplasty for acute myocardial infarction, transradial treatment is associated with decreased 2-year mortality rates and a reduction in the need for vascular surgery and/or blood transfusion compared with transfemoral intervention.

Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial

We sought to determine whether a transradial (TR) approach compared with a transfemoral (TF) approach was associated with improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in a post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data comparing the TR approach with the TF approach in patients with STEMI treated with primary PCI and contemporary anticoagulant regimens. In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340 patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints included the 30-day and one-year rates of major adverse cardiovascular events (MACE: death, reinfarction, stroke or target vessel revascularisation), non CABG-related major bleeding, and net adverse clinical events (NACE: MACE or major bleeding). TR compared to TF access was associated with significantly lower 30-day rates of composite death or reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95], p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year, the TR group still had significantly reduced rates of death or reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89], p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By multivariable analysis, TR access was an independent predictor of freedom from MACE and NACE at 30 days and one year. In patients with STEMI undergoing primary PCI with contemporary anticoagulation regimens in the HORIZONS-AMI trial, a TR compared with a TF approach was associated with reduced major bleeding and improved event-free survival.

Transradial Access for Renal Artery Intervention is Feasible and Safe

Transradial access for coronary intervention is associated with reduced access complications compared with transfemoral. Transradial access for renal artery intervention has been less well studied. Safety compared with transfemoral access is undetermined. We evaluated the feasibility of transradial renal intervention (n = 11 patients) and compared safety parameters with a matched group of transfemoral controls (n = 44). All transradial interventions were successful with no complications. Femoral crossover was required in one due to insufficient guide length. Compared with transfemoral, there were fewer access complications in the transradial group (0 of 11 vs 3 of 44, P = .06) but no differences in fluoroscopy time or contrast volumes (25.3 ± 14.4 vs 29.0 ± 25.1 minutes, P = .47; 83.0 ± 43.7 vs 82.6 ± 35.2 cc, P = .97). At follow-up (median 6 months), radial patency was 100%. Creatinine and systolic blood pressure had decreased (mean 1.4 ± 0.5 to 1.2 ± 0.5, P = .06; 160 ± 25 to 135 ± 17, P = .009). Elective transradial renal intervention is feasible and safe. Radial-renal distance is a limitation with available guides.

Learning Curve in Transradial Coronary Angiography

Transradial (TR) cardiac catheterization is underused, possibly because of perceived technical difficulty and longer procedure times. We compared TR to transfemoral (TF) coronary angiography as performed by experienced TF angiographers with varying TR skills. Data were analyzed for diagnostic angiography without ad hoc intervention over a 12-month period comparing TR to TF procedural and fluoroscopic times, contrast volume, and complication rates. Further analysis was performed according to operators' TR experience (radial expert [REx] vs non-radial expert [nREx]). In total 1,001 patients were identified (661 TR and 340 TF cases) with nRExs performing an average of 63 TR procedures each. All TF procedures were successful and 92% were successful for TR angiography; complication rates were similar regardless of access. Compared to TF procedures fluoroscopic times were longer in the all-operator TR group (5.3 vs 4.0 minutes, p <0.01) but total procedural times were not (TR vs TF 24 vs 22 minutes, p = NS). In the TR group nRExs had longer fluoroscopic and procedural times compared to RExs in the first 3 months of radial experience (8 vs 4.4 minutes, p = 0.02, and 32 vs 22 minutes, p <0.01, respectively); however, the 2 were equivalent in the final 3 months of analysis (5.2 vs 4.5 and 26 vs 19 minutes for nRExs and RExs, respectively, p = NS). Within the nREX group parameters improved in the last compared to the first 6 months (fluoroscopy 6 vs 7.3 minutes, p = 0.04; procedure time 26 vs 30 minutes, p = 0.04). In conclusion, TR coronary procedures appear to be a comparable alternative to TF procedures with a relatively short technical learning curve.

Comparison of percutaneous coronary intervention by transradial and transfemoral approaches

Objective To evaluate coronary arteriography and intervention treatment(PCI) by transradial and transfemoral approaches. Methods 195 patients undergoing PCI were divided into transradial group (98 cases) and transfemoral group(97 cases). The complications of operation, time of lying in bed after operation, length of stay were compared between two groups. Results The incidence rate of access site complication including hemorrhage and hematoma was significantly lower in transradial group (P＜0.01). The time of lying in bed after operation, length of stay were significantly shorter in transradial group than in transfemoral group(P＜0.01). Conclusion Transradial PCI can be successfully performed with excellent safety and effectiveness.There are fewer complication by the transradial approach. Key words: Radial artery; Femoral artery; Percutaneous coronary; Intervention; Postoperative complication

Transradial Versus Transfemoral Method of Percutaneous Coronary Revascularization for Unprotected Left Main Coronary Artery Disease: Comparison of Procedural and Late-Term Outcomes

This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy. The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared. Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method. Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively. In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.

E0641 Contrast study of transulnar artery PCI and transradial artery PCI

ObjectiveTo compare the feasibility and safety of TUA-PCI to TRA-PCI (transradial artery PCI).MethodsA total of 320 patients from 38 to 80 years old were randomised into transradial artery PCI group...

E0471 Clinical investigation of transradial approach for emergent percutaneous coronary intervention in patients with acute myocardial infarction

ObjectiveTo evaluate the safety and efficacy of transradial approach for emergent percutaneous coronary intervention in patients with acute myocardial infarction.MethodsWe analysed data from our single-center registry on 560 consecutive patients...

Comparative analysis between the transradial and transfemoral approach coronary intervention

Objective To evaluate the safety and success rates of transradial coronary intervention and to compare the advantages and disadvantages of coronary interventional procedures between the transradial and transfemoral approach in order to provide physician and patients a reasonable choice. Methods A total of 160 patients undergoing coronary interventional procedures were randomly divided into observer group (transradial group with 80 cases) and the control group ( transfemoral group with 80 cases). The success rate of catheterization, local pain during and after operation, complications, comfort after operation and hospitalization duration were compared between two groups. Results The success rate of catheterization was not different statistically between two approaches (P> 0.05 ). In transradial group, the complications, pains after operation and hospitalization time were better than in transfemoral group. Conclusions The transradial approach coronary intervention is safe, effective, with less pain after operation, with less influence on patients' comfort and no requirement of rest on the bed. Key words: Radial artery; Femoral artery; Percutaneous coronary intervention

Feasibility and safety of transradial approach for catheter ablation of idiopathic left ventricular tachycardia

The feasibility and safety of the transradial approach for catheter ablation of idiopathic left ventricular tachycardia (ILVT) have not been evaluated. The aim of this study was to investigate the feasibility and safety of transradial approach for catheter ablation in ILVT patients. Thirty consecutive ILVT patients with negative Allen's test undergoing catheter ablation via transradial approach were enrolled to compare the safety and efficacy with 30 other ILVT patients who previously underwent catheter ablation via transfemoral approach. Ablation was successfully performed in all patients. In the transradial group, the total procedural and the fluoroscopy time (42.8±6.9min and 9.7±1.9min, respectively) were significantly shorter when compared with transfemoral group (52.8±8.4min and 11.5±2.1min, respectively) (both P<0.05). The two groups were similar in the number of current applications (4.1±0.8 vs. 4.4±1.1, P>0.05), the power energy (47.3±7.3 vs. 49.7±6.9W, P>0.05), and the total duration of current application (110.3±15.6 vs. 112.3±16.5s, P>0.05), respectively. The duration of hospitalization in transradial group was shorter than that in transfemoral group (4.1±0.9 vs. 5.8±1.1days, P<0.05). During follow-up, there was no recurrence of tachycardia in all patients. One patient in transfemoral group developed access site complications while none occurred in the transradial group. The transradial approach is feasible and safe for catheter ablation of ILVT.

Rola badania dopplerowskiego w ocenie powikłań naczyniowych po cewnikowaniu serca z dostępu promieniowego lub udowego z użyciem StarClose – badanie w ramach RADIAMI II

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kowalczuk A, Chodór P, Streb W, Kurek T, Kalarus Z, Zembala M. Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2010;6(3):112-116. doi:10.5114/pwki.2010.16351. APA Kowalczuk, A., Chodór, P., Streb, W., Kurek, T., Kalarus, Z., & Zembala, M. (2010). Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 6(3), 112-116. https://doi.org/10.5114/pwki.2010.16351 Chicago Kowalczuk, Anetta M., Piotr Chodór, Witold Streb, Tomasz Kurek, Zbigniew Kalarus, and Marian Zembala. 2010. "Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 6 (3): 112-116. doi:10.5114/pwki.2010.16351. Harvard Kowalczuk, A., Chodór, P., Streb, W., Kurek, T., Kalarus, Z., and Zembala, M. (2010). Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 6(3), pp.112-116. https://doi.org/10.5114/pwki.2010.16351 MLA Kowalczuk, Anetta M. et al. "Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 6, no. 3, 2010, pp. 112-116. doi:10.5114/pwki.2010.16351. Vancouver Kowalczuk A, Chodór P, Streb W, Kurek T, Kalarus Z, Zembala M. Original paperThe utility of duplex ultrasound scanning in reporting the vascular complications after heart catheterization performed from new arterial approaches – radial or femoral artery access with StarClose usage – a substudy of the RADIAMI II trial. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2010;6(3):112-116. doi:10.5114/pwki.2010.16351.

A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

The aim of the study was to evaluate the safety, feasibility, and procedural variables by the transradial approach compared with the transfemoral access in a standard population of patients undergoing coronary catheterization. Coronary catheterization is usually performed via the transfemoral approach. Transradial access may offer some advantages in comparison with transfemoral access especially under conditions of aggressive anticoagulation and antiplatelet treatment. Between July 2006 and January 2008, a total of 1,024 patients undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Patients with an abnormal Allen's test, history of coronary artery bypass surgery, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded. Successful catheterization was achieved in 494 of 512 patients (96.5%) in the transradial and in 511 of 512 patients (99.8%) in the transfemoral group (p < 0.0001). Median procedural duration (37.0 min, interquartile range [IQR] 19.6 to 49.1 min vs. 40.2 min, IQR 24.3 to 50.8 min; p = 0.046) and median dose area product (38.2 Gycm(2), IQR 20.4 to 48.5 Gycm(2) vs. 41.9 Gycm(2), IQR 22.6 to 52.2 Gycm(2); p = 0.034) were significantly lower in the transfemoral group compared with the transradial access group. A median amount of contrast agent was similar among both groups. Vascular access site complications were higher in the transfemoral group (3.71%) than in the transradial group (0.58%; p = 0.0008) The findings of the present study show that transradial coronary angiography and angioplasty are safe, feasible, and effective with similar results to those of the transfemoral approach. However, procedural duration and radiation exposure are higher using the transradial access. In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.

Transradial approach to treat superficial femoral artery in‐stent restenosis

Transradial access reduces the incidence of access site complications of percutaneous revascularization procedures. However, in patients with peripheral vascular disease, the adoption of transradial approach for superficial femoral artery (SFA) angioplasty is usually prevented by the distance between the vascular access and the target lesions; thus, SFA angioplasty is commonly performed by transfemoral approach. Recently, low-profile balloons with extended shaft length became available, allowing to potentially address SFA lesions by transradial approach. As plain balloon angioplasty represents a valuable option for SFA in-stent restenosis treatment, we evaluated the feasibility of transradial approach in this clinical setting. Transradial balloon angioplasty of SFA diffuse in-stent restenosis was attempted in 12 patients aged 69.4 +/- 5.1 years. Six-French 125 cm long MP guiding catheters, 300 cm long 0.018'' guidewire, and low-profile 4 Fr compatible 180 cm long shaft balloons (5 and 6 mm in diameter and 80-150 mm in length) were used. The procedural success was 100%, and no complications occurred during the hospital stay. Compared with a matched group of patients in whom angioplasty was performed by trans-femoral approach, main procedural key data resulted similar except for the amount of administered contrast dye, which was slightly but significantly lower in transradial group (170 +/- 59 ml vs. 241 +/- 103, P = 0.03). In conclusion, with the currently available equipment, the transradial approach is feasible and represents a valuable alternative for treatment of patients with SFA in-stent restenosis.

Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI). Methods 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the data from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitalization, and the six-month follow-up results in both groups. Results Our results showed that the achievement ratio of arteriopuncture, cannulation time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56 min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min, respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 min for the transradial group and 27.89 ± 3.95 min(P < 0.05) for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 2.2% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days(P < 0.05) for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups(P > 0.05). Conclusion The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.

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.

New Access for Radiofrequency Catheter Ablation of Left-Sided Atrioventricular Accessory Pathways Safety and Efficacy of the Transradial Approach

The safety and efficacy of the transradial approach for radiofrequency catheter ablation (RFCA) of left-sided atrioventricular accessory pathways (APs) was evaluated in the present study. Included were 40 consecutive patients with type A Wolff-Parkinson-White (WPW) syndrome who underwent RFCA via the radial artery route, and 30 patients with type A WPW syndrome who underwent RFCA via the transfemoral approach (controls) were retrospectively chosen for control. All 45 APs in the 40 patients were successfully ablated: 35 APs were successfully blocked with 1 ablation attempt, and the other 10 APs were ablated after 2-4 attempts. Compared with the transfemoral approach, the total procedure time for the transradial approach was longer (40 +/- 7.7 vs 32.4 +/- 8.7 min, P<0.05) and the fluoroscopic time was similar (7.2 +/- 2.2 vs 7.9 +/- 3.9 min, P>0.05). There were no vascular complications in the transradial group, but 2 patients in the transfemoral developed local hematoma. There was no recurrence of arrhythmia in either group. The transradial approach is a safe and effective access for RFCA of left-sided APs.

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

INTRODUÇÃO: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O aces-so transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. MÉTODO: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clássica. RESULTADOS: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). CONCLUSÃO: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes.