Adjusted Weight Anticoagulation for Radial approach in Elective coronarography: the AWARE coronarography study

Schiano, P.; Chenilleau, M.-C.; Louembe, Jules; Monségu, Jacques

doi:10.4244/eijv6i2a39

Cited by 27 publications

(17 citation statements)

References 14 publications

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“…16 Whether the heparin is given intravenously or through the arterial sheath does not have an impact on RAO. 48 More recently, Schiano et al 49 randomly assigned 162 patients to 5000 U of heparin versus 50 U/kg with an upper limit of 5000 U. All patients received hemostasis with the TR band.…”

Section: Anticoagulationmentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

180

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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Section: Anticoagulationmentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

180

133

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“…3 For these reasons, some authors have suggested a preliminary angiogram of the arteries of the forearm through the introducer inserted into the radial artery. 4 Our strategy consisted of performing a radial artery puncture, inserting the sheath, injecting in situ vasodilators (verapamil), and then advancing the 0.35-inch J-wire through the radial sheath with the support of the catheter with no primary forearm angiogram.…”

Section: Discussionmentioning

confidence: 99%

Accordion Phenomenon in the Radial Artery : Should we Treat the Radial as a Coronary Artery ? = ظاهرة الأكورديون في الشريان الكعبري : هل ينبغي لنا معالجة الشريان الكعبري بمثابة الشريان التاجي ؟

Dahdouh¹,

Abdel-Massih²,

Sarkis³

et al. 2014

SQUMJ

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abstract:The accordion phenomenon is a well-known finding mechanism in the field of interventional cardiology. It is a benign condition and has mainly been described in tortuous coronary arteries during percutaneous coronary interventions. It is believed to be induced by a stiff guidewire. However, this phenomenon has not been observed previously in the radial artery. We present a case of accordion phenomenon in the radial artery, which was successfully resolved after the catheters and the wire were retrieved, with the pseudolesions found to have completely disappeared in subsequent image findings.

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“…The recommended intra‐arterial vasodilator cocktail included nitroglycerin 200 μg and verapamil 2.5 mg. Patients undergoing diagnostic cardiac catheterization received 50 U/kg of unfractionated heparin administered intravenously . When ad hoc PCI was performed, additional unfractionated heparin was administered to achieve a therapeutic level of activated clotting time.…”

Section: Methodsmentioning

confidence: 99%

Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention

Lavi

Cheema

Yadegari

et al. 2017

JAHA

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Background Radial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion ( RAO ) but might be associated with incomplete hemostasis. Methods and Results In total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20‐ and 60‐minute clamp application groups, respectively ( P =0.19). The incidence of grade 1 hematoma was higher in the 20‐minute group (6.7% versus 2.5%, P =0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20‐ and 60‐minute groups, respectively ( P =0.36). Requirement for clamp retightening (36% versus 16%, P =0.01) was higher among patients who had RAO . Need for clamp retightening was the only independent predictor of RAO ( P =0.04). Conclusions Ultrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60‐minute clamp duration is safe and provides good access site hemostasis with low RAO rates. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02269722.

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Adjusted Weight Anticoagulation for Radial approach in Elective coronarography: the AWARE coronarography study

Cited by 27 publications

References 14 publications

Radial Artery Patency After Transradial Catheterization

Radial Artery Patency After Transradial Catheterization

Accordion Phenomenon in the Radial Artery : Should we Treat the Radial as a Coronary Artery ? = ظاهرة الأكورديون في الشريان الكعبري : هل ينبغي لنا معالجة الشريان الكعبري بمثابة الشريان التاجي ؟

Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention

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