Needle versus cannula over needle for radial artery cannulation during transradial coronary angiography and interventions

Distal Versus Traditional Radial Approach for Coronary Angiography

PURPOSE

The aim of this study was to evaluate the efficacy and safety of distal radial (DR) versus traditional radial (TR) approach during coronary angiography.

METHODS

Two hundred patients scheduled to undergo transradial coronary angiography were randomized between the two approaches. Primary endpoint of the study was switching to another access site due to inability of successful target artery cannulation. Secondary endpoints were time to cannulation, total procedure duration, number of attempts, number of skin punctures and duration of manual hemostasis. Secondary safety endpoints were the rate of moderate or severe spasm, arm hematoma EASY class III or more and radial artery occlusion at discharge. Quality of life endpoint was the patient's preference of cannulation method at 30 days.

RESULTS

The primary endpoint was met in 30 patients (30%) from the DR group and 2 patients (2%) from the TR group (p < 0.001). The time of cannulation was longer in the DR group compared to the TR group (269 ± 251 s vs 140 ± 161 s, p < 0.001), but this did not affect the total procedural duration (925 ± 896 s vs 831 ± 424 s, p = 0.494). The number of attempts and the number of skin punctures were more in the DR group compared to the TR group (6.8 ± 6.2 vs 3.4 ± 4.5, p < 0.001 and 2.4 ± 1.7 vs 1.6 ± 1.2, p < 0.001, respectively). However, DR treated patients had faster manual hemostasis time compared to TR treated patients (568 ± 462 s vs 841 ± 574 s, p = 0.002). There were no differences recorded in the safety endpoints of moderate or severe spasm, EASY grade III or more radial hematomas or the incidence of radial artery occlusion after the procedure. Patients' preference to the randomized puncture sites was the same (79% vs 85%, p = 0.358).

CONCLUSION

Distal radial approach is associated with lower successful cannulation rates and shorter manual hemostasis time compared to the traditional radial approach.

Alternative access site choice after initial radial access site failure for coronary angiography and intervention

Background

Transradial access for coronary catheterization is more technically challenging compared to the traditional transfemoral approach and radial access failure is quite common. The aim of this study is to describe the additional steps after initial radial access site failure in a high specialized forearm approach center.

Methods

A retrospective evaluation of all coronary catheterizations performed in our Department between January 2016 and December 2016 was performed, with focus on arterial access.

Results

One thousand three hundred forty six procedures were evaluated. The initial access site used was right radial [1173 procedures (87.1%)], left radial [120 procedures (8.9%)], right ulnar [7 procedures (0.5%)], left ulnar [40 procedures (2.9%)] and femoral approach [6 procedures (0.4%)]. Radial artery cannulation failure was observed in 37 procedures (2.9% of 1293 procedures with initial radial approach). Failure of procedure completion after successful radial sheath insertion was observed in 46 procedures (3.6%). The alternative access site after initial radial approach failure was contralateral radial [43 procedures (51.8%)], ipsilateral ulnar [22 procedures (26.5%), contralateral ulnar [12 patients (14.5%)] and femoral approach [6 procedures (7.2%)].

Conclusion

Forearm arteries can be used as alternative access site after initial radial approach failure in order to reduce the use of femoral approach during cardiac catheterization.

One catheter or two? Tomayto or Tomahto?

This retrospective study compares the performance of transradial diagnostic procedures using the single versus Judkins catheter approach. The Judkins approach had a 15% lower patient radiation exposure than single catheter approach while fluoroscopy time was comparable. Future studies of comparing such techniques may always be limited by operator preference, experience, and comfort.