Intracoronary stent implantation via the brachial approach: A technique to reduce vascular bleeding complications

Abstract

To reduce the incidence of vascular complications of intracoronary stent implantation, we used the brachial approach. We attempted implantation of the Palmaz-Schatz stent via the brachial artery approach at 10 lesions in 9 patients. Stent delivery was successful at 8 lesions. Balloon angioplasty was successfully performed in the 2 failed cases, 1 of whom required surgical repair of the brachial artery. Intravenous anticoagulation was uninterrupted from the time of stent placement until therapeutic prothrombin times from oral warfarin therapy were obtained. Neither acute nor long-term major bleeding occurred in the 9 patients. There were no embolic events, myocardial infarctions, or deaths. One subacute thrombosis occurred, and the patient underwent bypass surgery. To evaluate the risks and benefits of the brachial approach, we compared these 9 patients with 41 who had stent placement by the femoral approach during the same period. Lesion characteristics were similar in these 2 groups. There were no significant differences in the success rate or angiographic outcome between the 2 groups. Seven (17%) patients in the femoral group had vascular access complications requiring surgery, compared with 1 (11%) in the brachial group. No patient in the brachial group required transfusion, compared with all 7 of the patients who had femoral vascular complications. The potential reduction in bleeding complications makes the brachial approach to stent implantation attractive in selected patients.

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“…The incidence of local complications is undoubtedly influenced by the size of equipment used in the procedure, the type of access, and the skill of the operator. At Columbia Medical Center in Phoenix, we have found that devices larger than 8 French ate more frequently associated with local complications and that femoral access is more often linked to these occurrences than brachial access [15].…”

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“…One thing is to attend forums discussing the benefit of the radial procedure or work with operators that perform these procedures on a routine basis. With over 25 years of experience performing the radial procedure, and after having written one of the earlier papers showing the benefit of the arm approach versus groin approach for PCI , we conduct frequent radial training programs to encourage our colleagues to perform this safer approach to modern day PCI. At the St. Luke's Medical Center in Phoenix, we looked at our last 12 month log of patients undergoing coronary intervention.…”