The Last Broken Barrier: Retrograde Radial Artery Recanalization Prior to Transradial Coronary Interventions

Sanz‐Sánchez, Jorge; Regazzoli, Damiano; Petriello, Gennaro; Reimers, Bernhard; Gasparini, Gabriele L.

doi:10.1016/j.carrev.2021.01.020

Cited by 2 publications

(6 citation statements)

References 4 publications

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Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only four previous reports tested the feasibility of RAO recanalization via DRA [ 12 , 13 , 14 , 15 ]. Gasparini et al described the same technique of balloonless dilatation and wiring directly through the needle [ 12 ]. Of the seven patients, five were successfully recanalized (71% success rate), choosing solely 0.014″ polymer-jacket coronary guidewires.…”

Section: Discussionmentioning

confidence: 99%

“…Of the seven patients, five were successfully recanalized (71% success rate), choosing solely 0.014″ polymer-jacket coronary guidewires. The subintimal tracking and reentry technique was used in 80% of their cases [ 12 ]. On the other hand, Ali et al’s patient complained of hand claudication after the first intervention, initially RAO being treated with an anticoagulant for four weeks without improvement [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…With the adoption of DRA, attempts to recanalize recent or chronic RAO have also increased, with promising results, but reporting is limited to case reports or case series [ 12 , 13 , 14 , 15 ]. The conclusion of these publications called for larger registries to investigate the prevalence of complications of radial angioplasty (perforation, hematoma, digital ischemia, etc.)…”

Section: Introductionmentioning

confidence: 99%

“…The conclusion of these publications called for larger registries to investigate the prevalence of complications of radial angioplasty (perforation, hematoma, digital ischemia, etc.) [ 12 ] and its long-term patency [ 13 , 14 ], which is perhaps the most important aspect of the prospect of reintervention, especially since RAO is asymptomatic in most cases and recanalization performed exclusively for hand ischemia is less common [ 15 ]. The aim of this study was to explore the feasibility, safety, and long-term patency of the recanalization of chronic RAO and to present some technical procedural insights.…”

Section: Introductionmentioning

confidence: 99%

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Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Achim

Kákonyi

Jambrik

et al. 2022

JCM

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Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Achim

Kákonyi

Jambrik

et al. 2022

JCM

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The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

Achim

Péter

Kákonyi

et al. 2022

Life

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In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand.

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The Last Broken Barrier: Retrograde Radial Artery Recanalization Prior to Transradial Coronary Interventions

Cited by 2 publications

References 4 publications

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

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