The transradial approach (TRA) has been used for diagnostic and interventional cardiology. It has not previously been determined how many times the same radial artery can be cannulated without complications. A total of 812 patients (502 men and 310 women) underwent angiography or angioplasty via the TRA between 1997 and 1999 at our institution with a total of 1,438 procedures. Sheaths were 5 (55%) or 6 Fr (45%). Dropout rates of 3.5% and 7.9% were found at the second TRA attempt in the men and the women, respectively. Of the 62 TRA failures, 56 (90%) were due to narrowing or occlusion of the radial artery after the previous TRA procedure. A third TRA procedure was possible in 90% of the men and 80% of the women. A fifth TRA procedure was possible in 70% of the men and 50% of the women. The dropout rates for TRA increased as successive punctures were performed. This was primarily due to vessel narrowing and occlusion occurring as a function of multiple punctures.

No abstract

No abstract

he use of contrast medium has recently increased in various fields, including coronary angiography, but reports of induction of spasm in the coronary artery caused by contrast media are rare. [1][2][3][4][5][6] In the case reported here, a stent was placed for restenosis after percutaneous transluminal coronary angioplasty (PTCA) in a patient with no history of coronary vasospastic angina pectoris, but spasm appeared to be induced by the contrast medium Iomeprol. Case ReportA 75-year-old man was admitted to our hospital on July 24, 1996, with a diagnosis of unstable angina pectoris. Coronary risk factors included hypertension, diabetes mellitus, and a history of smoking. Emergency coronary angiography, performed on July 24, showed 75% stenosis in segment 7 of the left anterior descending coronary artery (LAD) and 90% stenosis in segment 13 of the left circumflex coronary artery (LCx). The right coronary artery (RCA) exhibited chronic complete occlusion in segment 2Japanese Circulation Journal Vol.63, April 1999 but received well-developed collaterals from the LAD. Three-vessel PTCA was performed at the patient's request. The LCx and the RCA were successfully dilated by plain old balloon angioplasty (POBA) alone. Because the PTCA balloon caused vascular dissection in the LAD, a PalmazSchatz stent (P-S stent) was inserted. Repeat angiography 8 months later revealed restenosis in the RCA, and a 3.0×20 mm Gianturco-Roubin II stent (GR-II stent) was inserted into the RCA from segment 1 to segment 2. Further followup angiography performed 7 months later showed subtotal occlusion at the same site; PTCA was repeated and the vessel was successfully dilated. However, upon follow-up angiography 3 months later, chest pain occurred with bradycardia and hypotension immediately after completion of left and right coronary angiography; ST elevation was noted in ECG leads II and III, and aVF. Repeat angiography showed complete occlusion of the RCA that we considered to be due to a spasm occurring proximal to the GR-II stent. No signs of allergy such as urticaria, conjunctivitis or facial edema were noted at this point. Spasm was resolved by administration of 1 mg of atropine sulfate, 0.5 mg of norepinephrine, and an intracoronary infusion of 15 mg of isosorbide dinitrate (ISDN). Although 75% stenosis according to the American Heart Association (AHA) scale remained at the site of stent insertion after resolution of the spasm, PTCA was performed again because subtotal occlusion had been observed previously; the lesion was diffuse, and the patient had strongly desired the procedure. Because balloon-induced vascular dissection was observed distal to the GR-II stent at this point, a P-S stent was inserted into Jpn Circ J 1999; 63: 315 -318 (Received November 12, 1998; revised manuscript received December 24, 1998; accepted December 25, 1998 A Gianturco-Roubin II (GR-II) stent was inserted in a 75-year-old man who developed restenosis of the right coronary artery (RCA) after percutaneous transluminal coronary angioplasty (PTCA). Al...

(CAG) showed no significant irregularities (Fig. 1a). After the infusion of 2 ml of 99.5% ethanol at a rate of 0.5 ml/min to the second septal branch, CAG revealed that the branch was not occluded completely. Then we tried to do an additional ablation, and a balloon catheter was inserted into the branch again. To confirm whether an inflated balloon catheter was wedged in the septal branch, we injected contrast medium into it through this catheter. An aneurysmal formation was observed in the branch. Therefore, we discontinued the ablation. CAG also showed the same formation, in which the pooling of contrast medium disappeared for a few seconds (Fig. 1b, arrow). Follow-up CAG at 20 days post-PTSMA revealed enlargement of the aneurysmal formation (Fig. 1c, arrow), although changes in LVOTPG were not observed. Subsequent CAG at 9-months post-PTSMA showed spontaneous disappearance of the aneurysmal formation (Fig. 1d). An aneurysmal formation of the septal branch is a rare complication of PTSMA.