Transradial approach for coronary angiography and percutaneos coronary intervention: personal experience

Abstract

BackgroundThe transradial approach (TRA) has already become popular worldwide, but only recently has gained acceptance among Iraqi interventional cardiologists. The aim of this study is to document single operator experience with TRA and to test the benefit of assessing dual hand circulation before the TRA. It was an observational prospective study. Over a 2-year period (Jan 1, 2015, to Dec 31, 2016), 1561 patients underwent transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by a single operator. Patients were divided into two groups: A (the first 450 patients), in which dual hand circulation was assessed by Allen’s test or plethysmography/oximetry test before TRA, and B (1111 patients) in which TRA was done without assessing dual hand circulation.ResultsA total of 1561 patients were included, 69.1% males and 30.9% females. The mean age was (57 ± 10.0) years. We performed 1684 procedures (1005 CAG and 679 PCIs). The total transradial success rate was 95.6%, and PCI procedural success rate was 96.5%. The crossover rate from radial to femoral access was 4.4%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop. The main complication was radial artery occlusion (RAO) (3.7%). There were no cases of hand ischemia or complications that need surgical repair or blood transfusion. No statistically significant difference between groups A and B was observed regarding hand ischemia, the incidence of RAO, or the crossover rate.ConclusionsTRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.

Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta (“elephant head”): Impact on fluoroscopy time and contrast use

“…Among the reasons of failure to perform PCI via radial access are failure to engage the coronary arteries, inadequate catheter support, and tortuosity of the subclavian artery or aorta. [11][12][13] Interventionalists desire to overcome this obstacle and minimize crossing over to femoral approach. Based on the findings of the present study, we believe that identifying the maximum distance of thoracic aorta curvature may help minimize the crossover rate and prevent additional radiation exposure and contrast volume.…”

“…There can be multiple reasons for an operator to cross over from transradial to femoral. Among the reasons of failure to perform PCI via radial access are failure to engage the coronary arteries, inadequate catheter support, and tortuosity of the subclavian artery or aorta 11‐13 . Interventionalists desire to overcome this obstacle and minimize crossing over to femoral approach.…”

Patent hemostasis of radial artery: Comparison of two methods

“…Many studies have reported the safety and efficacy of performing coronary angiography via the transradial access. Transradial access is preferred over transfemoral artery access for percutaneous diagnostic and interventional procedures because it is associated with lower rates of vascular and hemorrhagic complications that lead to transfusions[ 5 , 10 - 12 ]. A systematic review and meta-analysis including 11707 patients who presented with ST-segment elevation myocardial infarction, reported an association between transradial access and reduction in 30-d mortality (relative risk, 0.72), major bleeding (relative risk, 0.60), and access-site complications (relative risk, 0.40) compared with transfemoral access[ 11 ].…”

“…RAO is a potential complication of coronary angiography using the transradial approach[ 5 , 10 ]. In randomized trials, RAO incidence ranged up to 10%[ 5 ].…”

Analysis of the Risk Factors Related to the Success Rate of Distal Transradial Artery Access in Patients with Coronary Heart Disease

“… 2 Nevertheless, transradial PCI is still associated with some complications, of which forearm radial artery occlusion (RAO) is the most common. Reports in the literature suggest that RAO has an incidence of 3–10% 3 or may be as high as 30%. 4 Distal transradial access (dTRA) is a new access approach for interventional therapy.…”