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Hampson R, Lawley A, Dobie G. Phantom Study of Arterial Localization using Tactile Sensor Array and a Normal Vs. Shear Pulse Pressure Propagation Method. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082657 DOI: 10.1109/embc40787.2023.10340678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Locating the radial artery reliably is a key challenge in reducing patient risks from complications in Trans-Radial Access, which is an important clinical method for catheterization, cardiac monitoring, and neuroendovascular procedures. New tactile sensing technology is being developed to bridge the skill, cost, and performance gap between ultrasonic needle guidance, and manual palpation, for use in developing countries. This paper further develops tactile artery localization with a novel algorithm for arterial localization based on the properties of a curved tactile sensor array. METHODS Using tactile sensor insensitivity to shear loading, coupled with a radial pulse wave propagation path, the position of the artery can be found at the intersection of a normal and tangential vector from the array corresponding to maximum and minimum pulse pressure measurement locations respectively. This was validated in a simple silicone phantom study Results: The proposed method measured with MAE= 0.58±0.25mm whilst the artery is within range of the tactile array, compared with 0.81±0.57mm for a comparative method of simple pulse localization. This showed improvement in arterial localization and repeatability, and was within 1 arterial radius, expected to reduce the risk of missing the artery, or perforating the side wall.Clinical Relevance- Robust and repeatable arterial localization is important for reducing the failure rate of trans-radial (and other arterial) procedures, and thus reducing the risk of harmful complications.
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Elfar S, Onsy A, Farouk MA. Clinical and Radiographic Predictors of Successful Coronary Angiography Through Right Radial Artery Access. Interv Cardiol 2023; 18:e21. [PMID: 37435602 PMCID: PMC10331560 DOI: 10.15420/icr.2023.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/23/2023] [Indexed: 07/13/2023] Open
Abstract
Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated with a higher diameter of the aortic knuckle (Group IV, 4.09 ± 1.32 cm versus Groups I, II and III combined, 3.26 ± 0.98 cm; p=0.015) and the width of the mediastinum (Group IV, 8.96 ± 2.88 cm versus Groups I, II and III combined, 7.28 ± 1.78 cm; p=0.009). The cut-off value for prominent aortic knuckle was 3.55 cm (sensitivity 70% and specificity 67.35%) and the width of mediastinum was 6.59 cm (sensitivity 90% and specificity 42.86%). Conclusion: Radiographic prominent aortic knuckle and wide mediastinum are valuable clinical parameters and useful predictors for transradial access failure caused by tortuosity of the right subclavian/brachiocephalic arteries or aorta.
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Affiliation(s)
- Sohil Elfar
- Cardiology Department, Faculty of Medicine, Port Said UniversityPort Said, Egypt
| | - Ahmed Onsy
- Cardiology Department, Faculty of Medicine, Ain Shams UniversityCairo, Egypt
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Prevalence and predictors of difficult vascular anatomy in forearm artery access for coronary angiography and PCI. Sci Rep 2022; 12:13060. [PMID: 35906409 PMCID: PMC9338070 DOI: 10.1038/s41598-022-17435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Transradial access has established as preferred access for cardiac catheterization. Difficult vascular anatomy (DVA) is a noticeable threat to procedural success. We retrospectively analyzed 1397 consecutive cardiac catheterizations to estimate prevalence and identify predictors of DVA. In the subclavian-innominate-aortic-region (SIAR), DVA was causing failure in 2.4% during right-sided vs. 0.7% in left-sided forearm-artery-access (FAA) attempts (χ2 = 5.1, p = 0.023). Independent predictors were advanced age [odds ratio (OR) 1.44 per 10-year increase, 95% confidence interval (CI) 1.15 to 1.80, p = 0.001] and right FAA (OR 2.52, 95% CI 1.72 to 3.69, p < 0.001). In the radial-ulnar-brachial region (RUBR), DVA was causing failure in 2.5% during right-sided vs. 1.7% in left-sided FAA (χ2 = 0.77, p = 0.38). Independent predictors were age (OR 1.28 per 10-year increase, 95% CI 1.01 to 1.61, p = 0.04), lower height (OR 1.56 per 10-cm decrease, 95% CI 1.13 to 2.15, p = 0.008) and left FAA (OR 2.15, 95% CI 1.45 to 3.18, p < 0.001). Bilateral DVA was causing procedural failure in 0.9% of patients. The prevalence of bilateral DVA was rare. Predictors in SIAR were right FAA and advanced age and in RUBR, left FAA, advanced age and lower height. Gender, arterial hypertension, body mass, STEMI and smoking were not associated with DVA.
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Predicting transradial access (TRA) difficulty - we're getting better: Reliably reducing TRA failure to < 1 - 2% - a ways to go. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:113-114. [PMID: 34996723 DOI: 10.1016/j.carrev.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
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Gragnano F, Jolly S, Mehta S, Branca M, van Klaveren D, Frigoli E, Gargiulo G, Leonardi S, Vranckx P, Di Maio D, Monda E, Fimiani L, Fioretti V, Chianese S, Andò G, Esposito G, Sangiorgi G, Biondi-Zoccai G, Heg D, Calabrò P, Windecker S, Romagnoli E, Valgimigli M. Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EUROINTERVENTION 2021; 17:e971-e980. [PMID: 34374343 PMCID: PMC9724886 DOI: 10.4244/eij-d-21-00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. AIMS We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. METHODS The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. RESULTS The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover. CONCLUSIONS The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.
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Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland,Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Sanjit Jolly
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shamir Mehta
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Dario Di Maio
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Emanuele Monda
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Luigi Fimiani
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Fioretti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Chianese
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Paolo Calabrò
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland. E-mail:
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Tahir H, Livesay J, Fogelson B, Coombes T, Patel C, Baljepally R. Use of the CHA 2DS 2-VASc score in assessing transradial approach failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:107-112. [PMID: 34140231 DOI: 10.1016/j.carrev.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Radial access is now considered the preferred approach for coronary angiography and percutaneous coronary intervention because of the low risk of vascular complications. However, radial access failure is not uncommon, leading to crossover to a different access site. The CHA2DS2-VASc score is used to estimate stroke risk in patients with atrial fibrillation. Our study aimed to assess the CHA2DS2-VASc score in predicting failure of the transradial approach, resulting in crossover to transfemoral access (TFA) for coronary angiography. METHODS We performed a single-center, non-randomized, retrospective study. The study included 1775 patients who underwent coronary angiography with or without subsequent percutaneous intervention between July 2018 and October 2019. The study population was divided into three groups based on the CHA2DS2-VASc score: low (≤2), intermediate (3-4), and high score (≥5) groups. The association between the CHA2DS2-VASc score and radial access failure was evaluated and compared between the groups. RESULTS A total of 197 patients (11.1%) had crossover to the femoral artery. A large percentage of patients (19.2%) had radial access failure in the high CHA2DS2-VASc score group (≥5) compared with 12.5% in the intermediate score group (3-4) and only 6.3% in the low score group (≤2). The highest crossover rate (42.9%) was observed in patients with a CHA2DS2-VASc score of 8. Higher CHA2DS2-VASc scores were also associated with increased fluoroscopy time, contrast administration, and radiation exposure. CONCLUSION The CHA2DS2-VASc score can predict failure of the transradial approach, with a score of ≥5 having the highest correlation of failure requiring crossover to TFA.
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Affiliation(s)
- Hassan Tahir
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America.
| | - James Livesay
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America
| | - Benjamin Fogelson
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America
| | - Tyler Coombes
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America
| | - Chirag Patel
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America
| | - Raj Baljepally
- University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America
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Stehli J, Duffy SJ, Koh Y, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S. Sex Differences in Radial Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome Are Independent of Body Size. Heart Lung Circ 2020; 30:108-114. [PMID: 32855068 DOI: 10.1016/j.hlc.2020.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/22/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radial access reduces bleeding and is associated with improved survival following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We evaluated the association between sex, markers of body size and radial access, and its impact on bleeding and mortality following PCI for ACS. METHODS AND RESULTS From 2013-2016, consecutive patients treated with PCI for ACS across 30 centres were prospectively entered into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariate logistic regression was used to analyse predictors of the primary endpoint of PCI access site and secondary endpoints of major bleeding and mortality. A total of 16,330 ACS patients (40.9% ST elevation myocardial infarction [STEMI]) underwent PCI (23.5% female). Women were older with significantly lower weight and height compared to men. Women had lower radial access use (41.6% versus 51.0%, p<0.001), with higher 30-day major bleeding (2.4% versus 1.4%, p<0.001) and mortality (4.4% versus 3.4%, p<0.001) than men. Female sex independently predicted lower radial access use (OR 0.75, 95% CI 0.68-0.83, p<0.001) while body surface area, height and body mass index did not. Female sex was an independent predictor of higher 30-day major bleeding (OR 1.38, 95% CI 1.05-1.81, p=0.019) and mortality in STEMI patients (OR 1.31, 95% CI 1.01-1.70. p=0.039). Radial access was associated with lower major bleeding (OR 0.70, 95% CI 0.53-0.91, p=0.009) and mortality (OR 0.60, 95% CI 0.48-0.75, p<0.001). CONCLUSIONS Radial access, despite being associated with lower bleeding and mortality, was used less frequently in women, independent of co-morbidities and objective markers of body size.
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Affiliation(s)
- Julia Stehli
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Youlin Koh
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia; Cardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.
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Schartz D, Young E, Guerin S. Transradial approach for pediatric interventions: A review and analysis of the literature. J Vasc Access 2020; 22:438-443. [PMID: 32781881 DOI: 10.1177/1129729820948688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population. METHODS We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic. RESULTS Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01). CONCLUSION Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.
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Affiliation(s)
- Derrek Schartz
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Emily Young
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stephen Guerin
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Semitko SP, Mel'nichenko IS, Karpeeva MI, Bolotov PA, Analeev AI, Azarov AV, Kruk SV, Klimov VP, Sorokin VV, Ioseliani DG. [Choice of an alternative access in failed endovascular intervention through the right radial artery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:76-83. [PMID: 32597887 DOI: 10.33529/angio2020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.
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Affiliation(s)
- S P Semitko
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - I S Mel'nichenko
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia
| | | | - P A Bolotov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - A I Analeev
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia
| | - A V Azarov
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - S V Kruk
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - V P Klimov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - V V Sorokin
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - D G Ioseliani
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Coomes EA, Haghbayan H, Cheema AN. Distal transradial access for cardiac catheterization: A systematic scoping review. Catheter Cardiovasc Interv 2019; 96:1381-1389. [PMID: 31785083 DOI: 10.1002/ccd.28623] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Systematically review the literature for cardiac catheterization and coronary angiography via distal transradial access (dTRA) and its outcomes. BACKGROUND dTRA, via anatomical snuffbox, may have several advantages over conventional transradial access (cTRA) for percutaneous cardiac procedures, including easier left-sided access for aorto-coronary grafts, future proximal radial artery preservation, and patient and operator comfort. However, its procedural characteristics and safety profile remain unclear. METHODS Ovid MEDLINE and EMBASE were searched from inception to September 2018. Two authors independently performed two-stage selection and data extraction. Reports assessing the dTRA approach for cardiac intervention in adults reporting any outcomes were eligible. Descriptive summary statistics were calculated from pooled data. RESULTS A total of 19 publications comprising 4,212 participants undergoing dTRA were included. Mean age was 63.8 years, and 23.0% were female. dTRA was primarily undertaken for assessment of stable coronary artery disease (87.6%), with 41.7% for diagnostic procedures and 46.9% undergoing percutaneous coronary intervention. The overall success rate for undertaking the dTRA approach was 95.4% (69-100%). Complications occurred in 2.4% of cases, of which the leading complications were bleeding/hematoma (18.2%). Complication rates did not significantly differ between dTRA and cTRA. The occurrence of radial artery occlusion in patients undergoing dTRA was low (1.7%). CONCLUSIONS Observational data demonstrate that dTRA is a safe and feasible method for percutaneous cardiac procedures, with high rates of procedural success and low rates of complication. As data comparing dTRA with cTRA remain limited, future high-quality randomized comparative studies are required.
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Affiliation(s)
- Eric A Coomes
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hourmazd Haghbayan
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada.,Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
| | - Asim N Cheema
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Maus V, Styczen H, Psychogios MN. Intracranial mechanical thrombectomy using a proximal balloon guide catheter via a transradial access. Interv Neuroradiol 2019; 25:508-510. [PMID: 30997860 DOI: 10.1177/1591019919844850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We present a description of a successful recanalization of an intracranial vessel occlusion by stent retriever-based mechanical thrombectomy with a proximal balloon guide catheter introduced via a transradial access. Therefore, we used the radial artery itself as a natural sheath, as the introduction of a balloon guide catheter would not have been possible through a common radial sheath.
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Affiliation(s)
- Volker Maus
- Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Hanna Styczen
- Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.,Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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12
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Effect of transient ulnar artery compression on radial artery diameter. Exp Ther Med 2018; 16:3735-3739. [PMID: 30250527 DOI: 10.3892/etm.2018.6632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/26/2018] [Indexed: 11/05/2022] Open
Abstract
The transradial approach is widely preferred in coronary procedures. A small radial artery diameter (RAD) is the most important factor affecting successful access. Various maneuvers and medications have been used to increase the RAD and thereby facilitate RA cannulation. Ulnar artery compression (UAC) for 30 min has been indicated to be effective in increasing the RAD and facilitating RA access. The aim of the present preliminary study was to assess the effect of transient UAC for 1 min on the RAD. A total of 151 patients were included in the present study. RA ultrasonography was performed at the level of the wrist. The UA was compressed for 1 min. The RAD was measured at baseline, at the end of UAC and at 1 min thereafter. The results indicated that the RAD was significantly smaller in diabetic vs. non-diabetic patients (2.35±0.43 vs. 2.50±0.39 mm, P=0.024) and in women vs. men (2.25±0.38 vs. 2.56±0.38 mm, P<0.001). At the end of UAC, the RAD was increased compared with that at baseline (2.45±0.41 vs. 2.62±0.41 mm, P<0.001), but it started to decrease thereafter, and the RAD measured at 1 min after stopping UAC was significantly smaller (2.62±0.41 vs. 2.55±0.40 mm, P<0.001), while remaining significantly larger than that at baseline (P<0.001). The RA peak systolic flow velocity also increased significantly during UAC (35.3±8.9 vs. 60.3±19.2 cm/sec; P<0.001). In conclusion, Transient UAC for 1 min significantly increased the RAD and the peak systolic flow velocity. Further studies with clinical endpoints are required for further exploration of the feasibility of this approach.
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Yılmaztepe MA, Uçar FM. Layer-specific strain analysis in patients with suspected stable angina pectoris and apparently normal left ventricular wall motion. Cardiovasc Ultrasound 2018; 16:25. [PMID: 30257673 PMCID: PMC6158830 DOI: 10.1186/s12947-018-0144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-invasive imaging tests are widely used in the evaluation of stable angina pectoris (SAP). Despite these tests, non-significant coronary lesions are not a rare finding in patients undergoing elective coronary angiography (CAG). Two-dimensional (2D) speckle tracking global longitudinal strain (GLS) imaging is a more sensitive and accurate technique for measuring LV function than conventional 2D methods. Layer-specific strain analysis is a relatively new method that provides endocardial and epicardial myocardial layer assessment. The aim of the present study was to evaluate longitudinal layer-specific strain (LSS) imaging in patients with suspected SAP. METHODS Patients who underwent CAG for SAP were retrospectively screened. A total of 79 patients with no history of heart disease and wall motion abnormalities were included in the study. Forty-three patients with coronary lesions > 70% constituted the coronary artery disease (CAD) group and 36 patients without significant CAD constituted the control group. Layer-specific GLS transmural, endocardium, and epicardium values (GLS-trans, GLS-endo, and GLS-epi, respectively) were compared between the groups. RESULTS Patients in the CAD group had significantly lower GLS values in all layers (GLS-trans: -18.2 + 2.4% vs -22.2 + 2.2% p < .001; GLS-endo: -20.8 + 2.8% vs -25.3 + 2.6%, p < .001; GLS-epi: 15.9 + 2.4% vs -19.5 + 1.9%, p < .001). Multivariate adjustment demonstrated GLS-trans as the only independent predictor of CAD [OR:0.472, CI (0.326-0.684), p < .001]. Additionally, the GLS values were all lower in myocardial perfusion scintigraphy (MPS) true-positive patients compared with MPS false-positive patients (GLS-trans: -17.7 ± 2.4 vs. -21.9 ± 2.4%, p < .001; GLS-endo: -20.2 ± 2.9% vs -24.9 ± 2.9%, P < .001; GLS-epi: 15.4 ± 2.6% vs. -19.2 ± 1.8%, P < .001). CONCLUSION Resting layer-specific strain as assessed by 2D speckle tracking analysis demonstrated that GLS values were reduced in all layers of myocardium with SAP and with no wall motion abnormalities. LSS analysis can improve the identification of patients with significant CAD but further prospective larger scale studies are needed to put forth the incremental value of LSS analysis over transmural GLS.
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Affiliation(s)
| | - Fatih Mehmet Uçar
- Department of Cardiology, School of Medicine, Trakya University, 22030, Edirne, Turkey
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Gilchrist IC. Sirens song or a bugle call to charge. Catheter Cardiovasc Interv 2017; 90:1105-1106. [PMID: 29226579 DOI: 10.1002/ccd.27418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/08/2022]
Abstract
Radial access for catheterization is associated with reduced bleeding and mortality across a spectrum of clinical conditions compared to femoral. Transradial technique is associated with a higher rate of access site failure but this is in those most likely to have a femoral-based complication. Improved outcomes will come with further radial technique refinement and not with a retreat to legacy femoral approaches.
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Affiliation(s)
- Ian C Gilchrist
- Division of Interventional Cardiology, MS Hershey Medical Center, Penn State University, College of Medicine, Heart & Vascular Institute, Hershey, Pennsylvania
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