Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

Abstract

SummaryThe transradial approach for coronary diagnostic and therapeutic interventions is a well-established, safe, and effective technique that has shown a success rate comparable to that of the transfemoral approach for chronic total occlusion (CTO) with less access site complications. Recently, the transulnar approach was also found to be a safe and feasible alternative for diagnostic and percutaneous coronary intervention (PCI). There is limited data on the efficacy and safety of the transulnar approach for CTO PCI. Here, we report the case of a patient who underwent coronary intervention for CTO via the bilateral ulnar approach. (Int Heart J 2010; 51: 137-140) Key words: Ulnar, Chronic total occlusion, Retrograde intervention T ransradial coronary intervention (TRI) has become a worldwide popular approach, with increasing data showing its safety and efficacy are comparable to those of standard transfemoral intervention (TFI). The advantages of TRI include relatively lower access site complications, early mobilization, and hence shortening of hospital stay.1) With the advancement of miniaturized percutaneous coronary intervention (PCI) devices, forearm vascular access, and operator experience, TRI is also now being used for more complex lesions.Chronic total occlusion (CTO) occurs in approximately 30-50% of all patients with significant coronary stenosis who have undergone coronary angiography.2) In a recent study, TRI was found to be comparable to TFI with respect to in-hospital major adverse cardiac events (MACE).3) However, radial artery (RA) access still has certain limitations such as the relatively smaller vessel size, higher incidence of vasospasm, and presence of some anatomical variations of RA (eg, radial loop, RA access originating from high brachial or axillary arteries). In such patients, the transulnar (TU) approach may provide a reasonable alternative, but TU had not received that much attention until it was reported in 2001.4) The TU approach was then compared to the transradial (TR) approach, which was found to be a safe and effective alternative with a high success rate and low access site complications. 5) In our literature search, we could not find any reports on TU for CTO intervention. Here, we report the case of a patient who underwent the bilateral TU retrograde approach for long CTO at the distal right coronary artery (RCA). Case ReportA 71-year-old man with a history of diabetes, hypertension, and hyperlipidemia presented with stable angina on regular medication. He was admitted for elective PCI for a totally occluded RCA. History of PCI included Taxus Liberte stenting (Taxus

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

“…All studies were published since 1989. Sample sizes ranged from 3 to 9609 individuals . The quality of the included studies reporting RAO was assessed by using the Newcastle–Ottawa scale (Table ).…”

“…Of those, 28 articles were excluded because either no RAO/UAO rates were reported or they were reviews/editorials or meta‐analyses not reporting original data on RAO/UAO rates, whereas 5 studies were excluded because they were duplicate reports (Figure ). Finally, 112 original articles assessing RAO and/or UAO were deemed eligible for our meta‐analysis, of which 99 cohorts from 92 studies publishing RAO…”

Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion

“…The TU approach for complex CTO intervention and carotid stenting has been reported in our center. 10,11) With a mean follow-up of 32.2 months, we further investigated the safety and outcome of TU catheterization for ipsilateral radial artery occlusion to perform either diagnostic coronary angiography or complex CTO intervention. No hand ischemia occurred, and no ulnar artery occlusion was detected by Doppler ultrasound or pulse oximetry.…”

The retrograde approach to coronary artery chronic total occlusions

“…Successful retrograde CTO PCI has been reported using bilateral radial [24,32,33] or ulnar [34] access, and, in a recent CTO PCI report, radial access had comparable results to femoral access [35]. However, dual femoral arterial access remains the preferred approach, as it provides more support than the radial access, allows use of larger, more supportive guide catheters (7 or 8 French), and is less likely to be affected by patient movement.…”