Feasibility and utility of pre‐procedure ultrasound imaging of the arm to facilitate transradial coronary diagnostic and interventional procedures (PRIMAFACIE‐TRI)

Chugh, Sanjay K.; Chugh, Yashasvi; Rao, Sunil V.

doi:10.1002/ccd.24585

Cited by 54 publications

(31 citation statements)

References 24 publications

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“…2 Adequate experience with transradial procedures has been shown to correlate well with reduced vascular complications and improved procedural success. 3,4 Pre-procedure 5 planning, which involves adequate assessment of forearm arteries by color doppler imaging; though not mandatory, helps quantify vessel diameters and/ or forearm vascular anomalies, aiding in the selection of adequate (largest, straightest, least anomalous) vascular access (radial or ulnar), access side (right or left) and catheter dimension (5F, 6F, 7F).…”

Section: Introductionmentioning

confidence: 99%

“…Selecting the straightest and biggest artery can help avoid severe (grade 3 to 4 per Chugh's grading of radial artery spasm) access spasm and procedure failure. 5 …”

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confidence: 97%

“…It can potentially be avoided if the sheath diameter: internal artery diameter ratio is kept <1:1, 7 thus emphasis on adequate catheter selection is essential. 5 Patients that have a short stature, small access artery diameters, low body mass indices, small wrist circumferences should be identified preoperatively as carrying a higher risk of radial artery spasm, puncture failure, and potential cross overs. 8 Even though the adequacy (size) of a radial artery can be appreciated by experienced operators (through simple palpation), the use of pre-procedure ultrasound of arm arteries (PPUAA) can be crucial for assessing access artery diameters and associated anomalies.…”

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confidence: 99%

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How to tackle complications in radial procedures: Tip and tricks

Chugh

Chugh²

2015

Indian Heart Journal

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Transradial interventions (TRI) are becoming increasingly popular because of accumulating recent evidence suggesting improved survival and reduced morbidity. Complications, though rare, do occur, especially for operators on their learning curve. The complications are best prevented by utilization of proper technique. Forearm hematoma are preventable and easy to treat, but a delay in detecting and managing them can lead to disastrous consequences compartment syndrome being the most dreaded one. This review deals with tips and tricks to prevent as also treat the common and rare complications.

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Section: Introductionmentioning

confidence: 99%

“…Selecting the straightest and biggest artery can help avoid severe (grade 3 to 4 per Chugh's grading of radial artery spasm) access spasm and procedure failure. 5 …”

mentioning

confidence: 97%

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confidence: 99%

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How to tackle complications in radial procedures: Tip and tricks

Chugh

Chugh²

2015

Indian Heart Journal

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“…2 The study's conclusion about correlation of multiple punctures with RAO may have been more relevant if the 2 confounding variables of heparinization and compression time had also been used optimally, in keeping with current practice, and based on recent data. 2 Although this is a insightful study, 1 further exploration into various anatomic and procedural correlates of RAO, including the reported benefits of accessing the largest and straightest forearm artery based on ultrasound, 4 needs to be further validated in large randomized settings.…”

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confidence: 99%

Letter by Chugh et al Regarding Article, “The Rotterdam Radial Access Research: Ultrasound-Based Radial Artery Evaluation for Diagnostic and Therapeutic Coronary Procedures”

Chugh

2016

Circ: Cardiovascular Interventions

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We would like to congratulate the authors for a comprehensive periprocedural ultrasound-based study 1 of radial arteries to help understand the pathophysiology of radial arterial injuries and occlusion after transradial procedures.There are, however, a few limitations of this work that may have confounded the outcomes and conclusions of the study, which we would like to highlight.The authors found radial artery occlusion (RAO) in 3.4% of all cases at 3 hours postprocedure and 3.9% on a 30-day follow-up, which is higher compared with previous ultrasound-based studies. 2In this article, RAO was associated with the presence of multiple punctures, but they had no relationship with smaller arterial size, 1 a term for which authors do not offer a clear definition. Furthermore, there was a lack of data in the article on the distribution of various radial artery diameters in patients requiring >1 puncture attempts (16.1%) or in patients developing RAO on follow-up. This information is relevant because radial arteries with smaller diameters often require multiple puncture attempts, facing greater intimal insult, and have hence been found to have higher postprocedure occlusions. 2,3A lack of correlation between small radial arteries and RAO in this study 1 may also have been on account of a limited number of patients with smaller radial arteries, although these data are unavailable.In addition, 56.7% of the patient cohort underwent a coronary angiogram and received 2500 IU of unfractionated heparin. Higher doses of heparin have been shown to reduce RAO compared with lower doses 2 without a risk of increased bleeding. Thus, lower heparin dosing could have influenced rates of RAO on follow-up, especially in situations where there was greater intimal insult in the setting of multiple punctures.The use of a prolonged nonocclusive compression protocol (3 hours in the study) may have had a negative influence on overall RAO occurrence because shorter compression times have been shown to significantly reduce rates of access artery occlusions. 2The study's conclusion about correlation of multiple punctures with RAO may have been more relevant if the 2 confounding variables of heparinization and compression time had also been used optimally, in keeping with current practice, and based on recent data. 2Although this is a insightful study, 1 further exploration into various anatomic and procedural correlates of RAO, including the reported benefits of accessing the largest and straightest forearm artery based on ultrasound, 4 needs to be further validated in large randomized settings. DisclosuresNone. Yashasvi Chugh, MDInternal

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“…In similar scenarios, using the contralateral ulnar artery for access may prevent procedure failure and crossover to femoral access, as the ulnar arteries are usually unaffected by such loops. 2,3 Information on ulnar artery anatomy may have been of use in patients with bilateral radial artery variants.…”

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confidence: 99%