Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions

Comparison of Long-Term Prognoses of Percutaneous Coronary Intervention via Distal Transradial and Conventional Transradial Access for Acute Coronary Syndrome

BACKGROUND

Distal transradial access (dTRA) has recently emerged as a new vascular access alternative for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). However, published data on long-term mortality and major adverse cardiac events after PCI via dTRA are inconclusive. The aim of this study was to compare the long-term prognoses of PCI via dTRA and conventional transradial access (cTRA) for acute coronary syndrome (ACS) after 1-3 years of follow-up.

METHODS

Patients who were diagnosed with ACS and underwent PCI between January 1, 2020, and December 31, 2021, were retrospectively enrolled. The patients were divided into two groups at a 1:1 ratio, subjected to propensity score matching (PSM) and then followed for 1-3 years after PCI. Cox proportional hazards regression was used to evaluate the relationship between the two access sites and clinical outcomes.

RESULTS

Among the 550 patients in the dTRA and cTRA groups, 11 (4.0%) and 19 (6.9%) died during the observation period, respectively. dTRA and cTRA had similar risks of all-cause mortality [hazard ratio (HR) =0.688; 95% CI=0.323-1.463; P=0.331] and major adverse cardiac events (MACEs, HR=0.806, 95% CI= 0.515-1.263; P=0.347) after PCI. The risk of cardiovascular mortality (HR=0.330, 95% CI= 0.107-1.105; P=0.053), TLR-MACEs (HR= 0.587, 95% CI=0.339-1.109; P=0.058), and unplanned revascularization (HR= 0.860, 95% CI=0.483-1.529; P=0.606) were not significantly different between the two groups.

CONCLUSIONS

PCI via dTRA has the same long-term prognoses as PCI via cTRA in ACS patients, and the compression time and bleeding rate are lower than those in patients undergoing PCI via cTRA.

Guidezilla™ guide extension catheter I for transradial coronary intervention

Background

Percutaneous coronary intervention (PCI) is the preferred treatment method for coronary artery diseases (CAD). This study aimed to evaluate the effectiveness and complications of the Guidezilla™ guide extension catheter I (GGEC I) in transradial coronary intervention (TRI).

Methods

This case series study included patients with CAD who underwent TRI using the GGEC I between August 2016 and January 2019 at the First Affiliated Hospital of Xi'an Jiaotong University.

Results

A total of 221 patients aged 65.1 ± 9.26 years were included. Coronary angiography results indicated that most patients (77.8%) had triple-vessel lesions, including 47.5% with chronic total occlusion (CTO). A total of 237 target lesions were treated, most being type C lesions (95.8%). The most common indication for GGEC I use was heavy calcification (67%), followed by extreme tortuosity (12.2%), extreme tortuosity and heavy calcification (10.9%), distally located lesion (4.5%), picking up the retrograde wire (3.2%), anomalous vessel origin (1.8%), and releasing the burr incarceration (0.4%). The mean operation time was 58 min, and the overall success rate was 94.1%. Four patients received a drug-coated balloon. No significant differences were found in operation time and success rate among the low (<23), intermediate (23-32), and severe (>32) CAD groups based on SYNTAX score stratification (P > 0.05). Two subacute thrombosis cases each were reported perioperatively, during hospitalization, and at the 1-month follow-up.

Conclusion

The GGEC I might have advantages for TRI and is unaffected by SYNTAX score stratification.