medigraphic.com
ISSN 1561-3011 (Electronic)

2020, Number 2

<< Back Next >>

Rev Cubana Invest Bioméd 2020; 39 (2)

Initial experience of cardiac catheterization through distal radial access in a femoralist center

Rodríguez A, Llerena RLD, López FLH, Zabala GA, López CG

Language: English
References: 24
Page: 1-13
PDF size: 344.91 Kb.


ABSTRACT

Objective: to share our experience in the radial distal approach to perform coronary angiography and / or dilation of coronary stenosis. The initial results are exposed in the access of the distal radial artery or in the so-called anatomical "snuff box".
Methods: The left or right radial distal artery was used as an access site in 6 patients admitted to the Institute of Cardiology and Cardiovascular Surgery for coronary angiography and dilatation of coronary stenosis between May 6 and June 6 of 2019. All with pulse present in their distal radial artery. In the laboratory, they had the access arm flexed with respect to the homolateral shoulder so that the hand was placed on their contralateral groin. In all cases, the operator was placed on the right side of the patient, to perform coronary angiography and / or dilation of coronary stenosis. During the hospital stay, the main demographic characteristics and complications were recorded.
Results: the average age of the patients was 72 +/- 10 years and 83.3% were men. We use the Judkins and Amplatz 6 and 5 French catheters for the procedures. Five admitted with the diagnosis of angina and one with severe aortic valve stenosis. In 5 patients, distal transradial coronary angiography was successfully performed. Only one patient experienced distal radial spasm, using in this case the ipsilateral proximal radial access, without making it necessary to approach the femoral artery. In total, 4 patients had coronary intervention, performing successfully in the 4 patients. The right coronary artery was the artery that required most of the intervention (3 patients). There were no cases of occlusion of the radial arteries, no hematoma of the hand, of the B.A.R.C scale greater than 1 was observed in any patient. Numbness of the hand was documented in none. The radial introducer was removed at the end of the procedure. Hemostasis was achieved with manual compression.
Conclusion: the distal radial approach is feasible in a selected group of patients as a procedure for coronary angiography and dilatation of coronary stenosis.


REFERENCES

  1. Bernat I, Horak D, Stasek J, et al. ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMIRADIAL trial. J Am Coll Cardiol. 2014;63:964-72.

  2. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409-20.

  3. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481-9.

  4. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465-76.

  5. Ferrante G, Rao SV, Jüni P, et al. Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a metaanalysis of randomized trials. JACC Cardiovasc Interv. 2016;9:1419-34.

  6. Vora AN, Stanislawski M, Grunwald GK, et al. Association between chronic kidney disease and rates of transfusion and progression to end-stage renal disease in patients undergoing transradial versus transfemoral cardiac catheterization-an analysis from the Veterans Affairs Clinical Assessment Reporting and Tracking (CART) program. J Am Heart Assoc. 2017;6:e004819.

  7. Andò G, Costa F, Trio O, et al. Impact of vascular access on acute kidney injury after percutaneous coronary intervention. Cardiovasc Revasc Med. 2016;17:333-8.

  8. Valle JA, Kaltenbach LA, Bradley SM, et al. Variation in the adoption of transradial access for ST-segment elevation myocardial infarction: insights from the NCDR CathPCI Registry. JACC Cardiovasc Interv. 2017;10:2242-54.

  9. Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989;16:3-7.

  10. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn. 1993;30:173-8.

  11. Bavishi C, Panwar SR, Dangas GD, et al. Meta-analysis of radial versus femoral access for percutaneous coronary interventions in non-ST-segment elevation acute coronary syndrome. Am J Cardiol. 2016;117:172-8.

  12. De Luca G, Schaffer A, Wirianta J, Suryapranata H. Comprehensive meta-analysis of radial vs femoral approach in primary angioplasty for STEMI. Int J Cardiol. 2013;168:2070-81.

  13. Carvalho MS, Calé R, Gonçalves Pde A, et al. Predictors of conversion from radial into femoral access in cardiac catheterization. Arq Bras Cardiol. 2015;104:401-8.

  14. Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017;13:851-7.

  15. Solans JG, Massó JFM. Quimioterapia de los tumores cerebrales. Neurología. 1988;3(1):19-25.

  16. Al-Azizi KM, Lotfi AS. The distal left radial artery access for coronary angiography and intervention: a new era. Cardiovasc Revasc Med. 2018;19(suppl):35-40.

  17. Amin AP, Patterson M, House JA, et al. Costs associated with access site and sameday discharge among Medicare beneficiaries undergoing percutaneous coronary intervention: an evaluation of the current percutaneous coronary intervention care pathways in the United States. JACC Cardiovasc Interv. 2017;10:342-51.

  18. Shah B, Burdowski J, Guo Y, et al. Effect of left versus right radial artery approach for coronary angiography on radiation parameters in patients with predictors of transradial access failure. Am J Cardiol. 2016;118:477-81.

  19. Dehghani P, Mohammad A, Bajaj R, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv. 2009;2:1057-64.

  20. Kado H, Patel AM, Suryadevara S, et al. Operator radiation exposure and physical discomfort during a right versus left radial approach for coronary interventions: a randomized evaluation. JACC Cardiovasc Interv. 2014;7:810-6.

  21. Soydan E, Akin M. Coronary angiography using the left distal radial approach-an alternative site to conventional radial coronary angiography. Anatol J Cardiol. 2018;19:243-8.

  22. Lee JW, Park SW, Son JW, et al. Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA). EuroIntervention. 2018;14:e995-e1003.

  23. Rashid M, Lawson C, Potts J, et al. Incidence, Determinants, and Outcomes of Left and Right Radial Access Use in Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom: A National Perspective Using the BCIS Dataset. JACC Cardiovasc Interv. 2018;11:1021-33.

  24. Shah RM, Patel D, et al. Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis. Catheter Cardiovasc Interv. 2016 Dec;88(7):1027-33.




2020     |     www.medigraphic.com