Transradial approach for coronary angiography and angioplasty

doi:10.1016/S0002-9149(99)80050-2

The American Journal of Cardiology

Volume 76, Issue 3, 15 July 1995, Pages 164-167

https://doi.org/10.1016/S0002-9149(99)80050-2 Get rights and content

Abstract

The transradial approach has currently been advocated as an alternative catheferization method for coronary angiography and angioplasty, due to the recent miniaturization of angioplasty equipment. The purpose of this study was to assess the practical clinical applicability of this method. From June to November 1994, 100 patients underwent coronary angiography and angioplasty with the transradial approach. Their mean age was 66.6 ± 11.2 years, and 79 were men. In 4, radial puncture was not successful, and in 3, femoral access was necessary to complete the procedure. Coronary angioplasty was performed in 63 patients (76 lesions) with angiographic success (per lesion) of 96%. In 5 patients, a stent was successfully implanted. All patients were ambulatory on the day after the angioplasty procedure. In 98% of the patients, the introducer was taken out 1 to 4 hours after the procedure by local compression using a special custom-made device. No patient required blood transfusion. Major complications occurred in 2 patients; both had a cerebrovascular accident (1 probably not procedure-related), and both recovered. A radial pulse was palpated in 91 of the patients before discharge, and in 6 others, adequate flow could be heard with Doppler. In 2 patients, radial flow was restored within several weeks. None of the patients suffered from ischemia of the hand. Two patients had a small pseudoaneurysm successfully treated by local compression. Thus, coronary angioplasty can be performed safely using the transradial approach with relatively few vascular complications and with better patient comfort. However, the procedure is more time-consuming initially compared with the transfemoral approach due to a learning curve regarding equipment selection and catheter manipulation.

Reference (6)

RozenmanY et al.
One stage coronary angiography and angioplasty
Am J Cardiol
(1995)
KiemeneijF et al.
Percutaneous transradial artery approach for the coronary Palmaz-Schatz stent implantation
Am Heart J
(1994)
JudkinsMP
Selective coronary arteriography, part I: a percutaneous transfemoral approach
Radiology
(1967)

There are more references available in the full text version of this article.

Cited by (176)

Open Radial Artery Study
2024, American Journal of Cardiology
Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still lacking. In our study, we aimed to evaluate the effect of patent hemostasis on early (24 hours) and late (2 weeks) RAO prevention. The Open Radial Artery Study was a single-arm, prospective, and multicenter study. The primary end points were early and late RAO at the vascular access site after transradial coronary procedures. Secondary end points were access site hematoma, pseudoaneurysm formation, arteriovenous fistula, and nerve injury. A total of 2,181 patients were analyzed (67% male, mean age 68 years). The mean interventional duration and hemostatic times were 75.6 ± 55.6 and 60 ± 5.6 minutes, respectively. Radial artery spasm occurred in 10% of patients (n = 218). Catheter kinking, radial artery rupture, or dissection were not observed during the procedure. RAO, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve damage was not observed in any of the patients in the early or late period. In patients who undergo coronary diagnostic or interventional procedures through transradial artery access, the patent hemostasis method seems a critical step in the prevention of early and late RAO.
Editorial: Transradial Access – to the Heart of the Matter and More
2020, Cardiovascular Revascularization Medicine
Hand Sensibility after Transradial Arterial Access: An Observational Study in Patients with and without Radial Artery Occlusion
2019, Journal of Vascular and Interventional Radiology
To evaluate hand sensibility after transradial access (TRA) in patients with and without radial artery occlusion (RAO).
In this study, 71 patients with and without RAO after TRA for a coronary intervention were studied (79% male, mean age 65 y ± 9). Sensibility testing of both hands was performed with the Semmes-Weinstein monofilaments test. The primary endpoint was abnormal sensibility, defined as diminished sensibility in at least 1 radial nerve–supplied dermatome. The contralateral hand served as control. The influence of TRA, RAO, and clinical characteristics on hand sensibility was evaluated.
In patients with RAO, more abnormal sensibility was observed on the RAO side compared with the control hand (72% vs 17%, P < .01). In patients without RAO, more abnormal sensibility was observed in the TRA hand compared with the control hand (43% vs 10%, P < .01). When analyzing all hands separately, TRA, RAO, and diabetes were independent predictors for abnormal hand sensibility in a multivariate model (odds ratio 3.8, 95% confidence interval 1.4–9.8, P < .01; odds ratio 3.0, 95% confidence interval 1.1–8.5, P = .03; odds ratio 3.5, 95% confidence interval 1.4–8.6, P < .01).
TRA and RAO are associated with diminished hand sensibility.
Influence of radial anatomy on pain experienced during transradial coronary angiography
2016, International Journal of Cardiology
Citation Excerpt :
Coronary angiography is an important diagnostic and therapeutic procedure in modern cardiology practice. The trans-radial approach has overtaken the trans-femoral approach to coronary access in recent years, due to the rare incidence of serious complications at the puncture site, elimination of the need to limit the patient's activity and the possibility of early patient discharge [1,2]. Radial artery anatomy has previously been shown to vary with resultant variation in procedure success, with anomalies found in approximately 10–20% of the population [3–5].
The transradial route has become the primary approach for coronary angiography with the presence of radial artery anomalies found to be 10–20%. There has been limited study on the influence of these anomalies on procedural pain. Our aims were to determine local prevalence of the high radial origin (HRO) anatomical variant; to investigate factors influencing transradial procedural pain; and to determine if HRO specifically was associated with increased pain.
Radial artery anatomy was characterized by arteriography in sequential patients undergoing angiography. Patients were asked to mark their perceived procedural pain on a visual analog scale, which was converted to a pain score.
382 patients were enrolled, 5 were excluded. There were 259 males (68.7%) and 118 females (31.3%). HRO was present in 51 patients (13.5%). Overall mean pain score was 2.6 (SD 2.5). HRO was associated with a higher mean pain score than normal anatomy (3.3 (SD 2.9) vs. 2.4 (SD 2.4) p = 0.027). HRO was not associated with increased procedural failure, screening time or procedure time. When pain score was dichotomized into mild pain (< 4.0) and moderate-to-severe pain (≥ 4.0), HRO was associated with almost double the frequency of moderate-to-severe pain (37.2% vs. 21.1%, p = 0.012). Using a logistic regression model, only female gender, younger age and HRO remained significant predictors of moderate-to-severe pain.
There was significantly increased pain in patients with HRO without increased procedure/screening time or procedural failure. Female gender and younger age were also found to be significant predictors of increased pain.
Strategies to traverse the arm and chest vasculature
2015, Interventional Cardiology Clinics
Coronary angiography safety between radial and femoral access
2014, Egyptian Heart Journal
Citation Excerpt :
Recent technological advances have enabled the miniaturization of diagnostic catheters as well as the equipment for percutaneous transluminal coronary angioplasty. Owing to this miniaturization, the percutaneous arm approach via the radial artery is becoming more popular throughout the world as an alternative to the femoral artery technique.2–12 Advantages of this approach include a lower incidence of access site complications, earlier patient ambulation, improved patient satisfaction, and lower cost.2–4,7,11–13
One of the major criticisms of the radial approach is that it takes longer overall procedure and fluoroscopy time, which means not only more staff will be exposed during the procedures, but they will also stand close to the patient where rates of radiation scattered by the patient are higher. The aim of this study was to evaluate the safety of the radial versus femoral artery approach in our institution’s routine coronary angiography practice.
All cases of diagnostic coronary angiography (CA) over a 23 month period at a tertiary care hospital were reviewed for this analysis. Procedure duration was calculated as a total in laboratory catheter time. Contrast volume and fluoroscopy time were recorded, as it is correlated to catheter manipulation.
Eight hundred patients who underwent a diagnostic CA were included in this study. The radial approach was used in 586 patients (73.25%) and the femoral approach in 214 patients (26.75%). Comparing the radial and femoral approaches, fluoroscopy and procedure times were not significantly different (3.43 ± 1.19 vs 3.86 ± 1.49 min, P = 0.215 and 31.87 ± 9.61 vs 33.24 ± 10.33 min, P = 0.170, respectively). While contrast utilization during the procedure was significantly lower in the radial than the femoral approach (67.63 ± 25.49 vs 81.53 ± 24.80 mL respectively, P = 0.03).
Transradial coronary angiography can be safely performed for the patient and the professional staff members as the transfemoral approach.

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Transradial approach for coronary angiography and angioplasty

Abstract

Am J Cardiol

Am Heart J

Selective coronary arteriography, part I: a percutaneous transfemoral approach

Radiology