Mustafa YURTDAŞ, Yüksel KAYA, Edip GÖNÜLLÜ

Transradial approach in the diagnosis and treatment of coronary artery disease: a 2-center experience

To document the safety, success, and complications of transradial coronary procedures. Materials and methods: This retrospective study consisted of 427 patients who had undergone transradial coronary angiography and/or angioplasty between June 2010 and May 2012. The main outcome measures were the procedural safety, success rate, and complications associated with transradial interventions. Results: Procedural success rate was 93.2% (398/427), with cannulation time of 2.1 ± 1.4 min, diagnostic time of 5.6 ± 2.1 min, fluoroscopy time of 9.5 ± 6.6 min, and total procedure time of 47.1 ± 20.2 min. The main causes for unsuccessful procedures were failed radial puncture (11 patients), serious radial artery spasm (12 patients), and distinct tortuosity (5 patients) and severe proximal stenosis (1 patient) of the right subclavian artery. Of 398 patients, 345 (86.7%) underwent both coronary angiography and angioplasty, while the remaining 53 (13.3%) had coronary angiography only. Major complication was recorded in only 1 patient (transient ischemic attack), whereas minor complications were observed in 76 patients (17 with symptomatic sinus bradycardia, 12 with venous thrombosis, 22 with hematoma, and 25 with radial artery occlusion). Conclusion: Our experience revealed that the transradial approach is a safe and feasible method for coronary procedures in patients with various manifestations of coronary disease.

Anahtar Kelimeler:

Key words: Radial artery, coronary disease, angiography, angioplasty

Transradial approach in the diagnosis and treatment of coronary artery disease: a 2-center experience

Keywords:

Key words: Radial artery, coronary disease, angiography, angioplasty,

PDF

___

Blankenship JC, Hellkamp AS, Aguirre FV, Demko SL, Topol EJ, Califf RM. Vascular access site complications after percutaneous coronary intervention with abciximab in the evaluation of c7E3 for the prevention of ischemic complications (EPIC) trial. Am J Cardiol 1998; 81: 36–40.
Brener SJ, Barr LA, Burchenal JE, Katz S, George BS, Jones AA, Cohen ED, Gainey PC, White HJ, Cheek HB et al. Randomized, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction. ReoPro and Primary PTCA Organization and Randomized Trial (RAPPORT) Investigators. Circulation 1998; 98: 734–741.
Cantor WJ, Kaplan AL, Velianou JL, Sketch MH Jr, Barsness GW, Berger PB, Ohman EM. Effectiveness and safety of abciximab after failed thrombolytic therapy. Am J Cardiol 2001; 87: 439–442.
Burzotta F, Trani C, Mazzari MA, Tommasino A, Niccoli G, Porto I, Leone AM, Tinelli G, Coluccia V, De Vita M. Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures. Am Heart J 2012; 163: 230–238.
Kiemeneij F. Prevention and management of radial artery spasm. J Invasive Cardiol 2006; 18: 159–160.
Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML. Thrombolysis in Myocardial Infarction (TIMI) Trial – phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 1988; 11: 1–11.
Stella PR, Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn 1997; 40: 156–158.
Campeau L. Percutaneous radial artery approach for coronary angioplasty. Catheter Cardiovasc Diagn 1989; 16: 3–7.
Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Catheter Cardiovasc Diagn 1993; 30: 173–178.
Yalçınkaya S, Kumbasar D, Değer N. Transradyal koroner stent uygulanan bir olgu. Turk Kardiyol Dern Ars 1996; 24: 446–448 (article in in Turkish).
Louvard Y, Pezzano M, Scheers L, Koukoui F, Marien C, Benaim R, Goy P, Lardoux H. Coronary angiography by a radial approach: feasibility, learning curve. One operator’s experience. Arch Mal Coeur Vaiss 1998; 91: 209–215 (article in French with an abstract in English).
Kedev S. Transradial and transulnar access for percutaneous coronary interventions. Turk Kardiyol Dern Ars 2011; 39: 332– 3
Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, Vander Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the ACESS study. J Am Coll Cardiol 1997; 29: 1269–1275.
Ziakas AG, Koskinas KC, Gavrilidis S, Giannoğlou GD, Hadjimiltiades S, Gourassas I, Theofilogiannakos E, Economou F, Styliadis I. Radial versus femoral access for orally anticoagulated patients. Catheter Cardiovasc Interv 2010; 76: 493–499.
Pancholy SB, Patel TM. Effect of duration hemostatic compression on radial artery after transradial access. Catheter Cardiovasc Interv 2012; 79: 78–81.
Uhlemann M, Möbius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M, Adams V, Thiele H, Linke A, Schuler G et al. The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. J Am Coll Cardiol Interv 2012; 5: 36–43.
Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion – patent hemostasis evaluation trial (PROPHET Study): A randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 2008; 72: 335–340.