Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses

Abstract

s opposed to 1-or 2-vessel coronary artery diseases (CAD), patients with unprotected left main artery disease carry poor outcomes if left unrevascularized. 1,2 Percutaneous coronary intervention (PCI) is regarded as a potential alternative management of unprotected left main coronary artery (ULMCA) disease to coronary artery bypass graft surgery (CABG) in selected patients due to comparable short-term clinical results. [3][4][5] Given the high percentage of distal bifurcation lesions and the large vessel diameter in ULMCA disease, most PCI for ULMCA stenoses are performed via the transfemoral approach using either 7 or 8 French (Fr) guiding catheters. [6][7][8][9] With recent advances in PCI instruments and techniques, most coronary lesions can now be safely treated via the transradial approach with a high procedural success rate and relatively few local vascular complications. 10,11 Nevertheless, the literature review reveals few case reports regarding transraCirculation Journal Vol.71, June 2007 dial stenting for ULMCA disease and only one small-scale study comparing the transradial and the transfemoral approach for both protected and unprotected left main PCI. [12][13][14][15] Thus, the feasibility and safety of routine transradial stenting for ULMCA stenoses remains unclear. To elucidate the feasibility and safety of this procedure, we retrospectively reviewed the success rate, in-hospital complications and 1-year outcomes of patients undergoing transradial coronary stenting for ULMCA stenoses in our medical facility. Methods Study Population and ProceduresAll patients undergoing elective coronary stent implantation in Chang Gung Memorial Hospital -Kaohsiung Medical Center, between June 2001 and August 2006, for ULMCA diseases with diameter stenosis ≥50% were selected for retrospective analysis. Patients presenting with ST-segment elevation acute myocardial infarction (MI) were excluded from the present study. Instead of surgery, PCI was chosen when suitable anatomy for stenting via a percutaneous approach was present and CABG was considered high risk owing to the presence of either old age or comorbidity, or in cases involving simple patient preference, which was defined as CABG eligibility. The unilateral radial artery was punctured routinely for the initial coronary angiogram at our institute unless patients had positive Allen's test, weak radial artery pulsation, wrist joint deformity or a local wound unsuitable for this approach. If the puncture of bilateral radial arteries failed, either the Circ J 2007; 71: 855 -861 (Received November 28, 2006; revised manuscript received February 13, 2007; accepted March 7, 2007) Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery StenosesCheng-I Cheng, MD* , **; Chiung-Jen Wu, MD**; Chih-Yuan Fang, MD**; Ali A. Youssef, MD**; Chien-Jen Chen, MD**; Shyh-Ming Chen, MD**; Cheng-Hsu Yang, MD**; Shu-Kai Hsueh, MD**; Hon-Kan Yip, MD**; Mien-Cheng Chen, MD**; Morgan Fu, MD**; Yuan-Kai Hsieh, MD** Background Percutaneous corona...

Safety and Efficacy of Transradial vs Transfemoral Arterial Primary Coronary Angioplasty for Acute Myocardial Infarction Single-Center Experience

“…[6][7][8][9][10][11][12] The transradial arterial approach (TRA), which is a fairly simple route of access 13,14 for catheter-based coronary intervention, has been developed for more than 15 years and since the safety and efficacy of this method was fully discussed and validated, 13,15 it has become a widely used approach, especially in Asia, for elective percutaneous coronary intervention (PCI). [15][16][17][18][19] Recent studies has further indicated that TRA is safe and efficacious for elective coronary angiographic studies of outpatients, 20 elective left main coronary intervention, 21 cerebral angiographic studies or vertebral or carotid stenting. 22,23 So currently, the TFA and TRA are the most popular vascular access routes for various types of PCI worldwide, but while the safety and efficacy of the TFA approach for acute myocardial infarction (AMI) patients undergoing primary PCI have been extensively discussed, 3,24,25 relevant issues for using the TRA for primary PCI have not been fully investigated 26 in an era when TRA for primary PCI is already daily practice in some medical centers.…”

What is the Best Way to Treat Left Main Coronary Artery Disease?

“…We previously reported the feasibility and safety of transradial stenting for ULMCA stenosis. 4 The 1-year TLR rate of left main coronary lesions and cardiac death rate were 14.2% and 3.5%, respectively. Park and Kim reported acceptable long-term outcomes of PCI with DES to treat ULMCA stenoses.…”

Transradial Coronary Intervention as the Primary Approach for Acute Myocardial Infarction

“…9 Finally it is time to consider TRI as the primary approach for emergency PCI for ST elevation myocardial infarction (STEMI). Bleeding complications are a frequent problem in PCI for STEMI because of the use of IIbIIIa inhibitor or tPA.…”