The Impact of Using a Larger Forearm Artery for Percutaneous Coronary Interventions on Hand Strength: A Randomized Controlled Trial

Platelet reactivity and activated clotting time predict hemorrhagic site complications in patients with chronic coronary syndromes undergoing percutaneous coronary interventions

BACKGROUND

Radial access is preferred in patients with chronic coronary syndromes (CCSs) treated with ad hoc percutaneous coronary intervention (PCI). Antithrombotic and antiplatelet treatment before PCI may affect outcomes at vascular access sites. QuikClot Radial is a kaolin-based band that may shorten hemostasis time. Using point-of-care testing, we investigated the effect of antithrombotic and antiplatelet treatment on access-site complications.

METHODS

This prospective observational study included consecutive patients with CCS on chronic aspirin therapy referred for ad hoc PCI. The activated clotting time (ACT), global thrombosis test and VerifyNow P2Y 12 test were done sequentially after unfractionated heparin (UFH) and clopidogrel administration. Patients were monitored for radial artery patency, bleeding and local hematoma until discharge.

RESULTS

We enrolled 40 patients [mean age, 68.8 ± 8.8 years; men, 30 (75%)] who received UFH (median dose, 8000 IU; interquartile range, 7000-9000 IU) and clopidogrel (600 mg). All radial arteries remained patent during follow-up. Local bleeding and hematomas were noted in 11 patients (27.5%) each. Patients with bleeding had lower mean platelet activity at 2 h [122.5 ± 51 platelet reactivity units (PRU) vs. 158.7 ± 43 PRU, P  = 0.04] and higher ACT (216.9 ± 40 s vs. 184.6 ± 28 s, P = 0.006) than patients without bleeding. An ACT >196 s at 2 h predicted bleeding or hematoma (AUC, 0.72; 95% CI, 0.56-0.85, P = 0.008).

CONCLUSION

Lower platelet activity and higher ACT after PCI were associated with higher bleeding risk at a vascular access site. Point-of-care testing of ACT after the procedure may help identify patients with CCS undergoing PCI who are at higher risk of access-site bleeding.

A narrative review of history, advantages, future developments of the distal radial access

This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.

Delayed ulnar artery pseudoaneurysm presentation after percutaneous cardiac intervention: A case report and review of the literature

PURPOSE

Here we present a case of a 62-year-old female with a delayed ulnar artery pseudoaneurysm presentation after cardiac catheterization.

CASE REPORT

A 62-year-old woman with multiple medical comorbidities including end-stage renal disease (ESRD) on hemodialysis (HD) and atrial fibrillation on tablet apixaban who presented 8 weeks after cardiac catheterization through right ulnar artery access with a pulsatile mass, pain, and tingling of her right-hand fingers. Ultrasound exam confirmed presence of ulnar artery pseudoaneurysm with >2 cm active chamber. This pseudoaneurysm was repaired via forearm exploration, evacuation of hematoma, and primary repair with non-absorbable sutures.

CONCLUSION

We report a case of delayed ulnar artery pseudoaneurysm presentation following cardiac catheterization through the right ulnar artery. Open surgical repair offers a definitive addressal of ulnar artery pseudoaneurysm and removes ulnar nerve compressive neuropathy with less risk of distal embolization in patients with delayed pseudoaneurysm presentation whenever ultrasound-guided thrombin injection (UGTI) is contraindicated.

Comparison of the effects of three kinds of hand exercises on improving limb function in patients after transradial cardiac catheterization

Objectives

This study aimed to compare effects of different hand exercises on improving limb function in patients after transradial cardiac catheterization.

Methods

This single-center, randomized clinical trial was conducted from August 20, 2020, to July 20, 2021, at an academic medical center. A total of 102 participants were selected from a Class A tertiary hospital in Nanjing, China and randomized into three groups: finger exercise group (n = 34), acupoint massage group (n = 34), and handgrip exercise group (n = 34). Symptoms of edema and pain were defined as primary outcomes, while skin temperature and degree of bleeding as secondary outcomes, which were monitored and measured 1, 2, and 4 h, after the intervention.

Results

Among the 99 participants who completed the process, the palm edema was gradually relieved in the handgrip exercise group at 2 h (H = 6.710, P = 0.035) and 4 h (H = 10.060, P < 0.001) following the intervention. The edema of fingers in the handgrip exercise group was obviously relieved at 2 h (H = 9.353, P < 0.01) and 4 h (H = 10.699, P < 0.001) following the intervention compared with the other two groups. In addition, the pain score at 4 h (H = 7.048, P = 0.029) was clearly decreased in the handgrip exercise group. However, there was no significant difference in the punctured limb's skin temperature (H = 0.922, P = 0.631) and the degree of bleeding (H = 0.123, P = 0.940) among the three groups.

Conclusions

We found that handgrip exercise is more effective in reducing the edema of the limbs than finger exercise and acupoint massage.