Background: Radial artery occlusion (RAO) is a clinically silent complication of transradial catheterization but may predispose to hand ischemia. Factors associated with this complication are the diameter of catheters and sheaths, the dose of heparin, repeated transradial procedures and the type of compressive dressing applied. The objective of this study was to evaluate if there is an association between reused hydrophilic vascular introducers and RAO. Methods: Patients undergoing transradial catheterization were randomized to receive brand new introducers (Group I-GI) or reprocessed in troducers (Group II-GII). The presence of RAO was evaluated at 24 hours (early) and day 30 (late) with the reverse Barbeau test. Results: Two hundred and twenty-eight patients were assigned to GI (n = 100) and GII (n = 128). Mean age was 60.1 ± 10.6 years vs. 59.4 ± 10.9 years (P = 0.64), 49% vs. 35.2% (P = 0.03) were female and 25% vs. 27.3% (P = 0.70) were diabetic. An total early RAO incidence of 10.5% and a late RAO incidence of 9.1% were observed. Ten GI patients (10%) had early RAO when compared to 14 (19.9%) in GII (χ 2 = 0.05; HR: 1.09; P = 0.82). On the 30-day follow-up RAO was observed in 6 GI patients (7.5%) when compared to 11 GII patients (10.4%) (χ 2 = 0.45; HR = 1.38; P = 0.50). Conclusions: In our study no association was found between reused vascular introducers and early and late RAO in patients undergoing cardiac catheterization.
A 64-year-old female presented with pulmonary edema and cardiogenic shock after coronary arteriography that showed severe suboclusive lesion in the left main coronary artery (LMCA) in a dominant left coronary system. The patient succesfully underwent urgent angioplasty with stent deployment in the LMCA. After an uneventful period, the patient was discharged at day six.Percutaneous transluminal coronary angioplasty of unprotected LMCA is considered a high-risk procedure, contraindicated in elective situations; however, it can be performed in specific cases of clinically unstable patients with acute myocardial infarction (AMI), unstable angina with contraindication for surgery, or critical patients in whom surgical mortality would be very high. In these cases, angioplasty together with stenting may have more advantages than angioplasty alone, such as less acute, and subacute complications and a lower restenosis rate. We report here a case of a patient in cardiogenic shock due to instabilization of a subocclusive lesion in LMCA treated with urgent stenting. Case ReportA 64-year-old female diabetic patient with mitral stenosis had undergone open commissurotomy 4 years earlier.She had many episodes of substernal chest pain, and profuse sweating followed by dyspnea unrelated to effort in the prior two weeks. She was recommended for heart catheterization and coronary angiography.Coronary angiography was performed on October, 6, 1998 and after right femural arterial venous puncture two 6 F sheaths were placed. This study was conducted first with right heart catheterization for evaluation and registration of right atrial pressure (RA), right ventricular pressure( RV), pulmonary artery pressure (PA), and pulmonary capillary wedge pressure ( PCW) followed by right ventriculography.The pressures were: RA mean = 5mmHg; RV = 45/ 5mmHg; PA = 45/18mmHg; PCW mean = 22mmHg. A pattern of left atrium emptying compatible with moderate mitral stenosis was detected in the left phase of the right ventriculography.After that, cinecoronariography and left ventriculography studies were carried out. Judkins coronary catheters (JR and JL) and pigtail catheters size 6F were used. The right coronary artery (RCA) was shown to have moderate lesions in the ostia; the left coronary artery (LCA) was barely cannulated, and its study showed a severe subocclusive stenosis, (>90%) in the middle portion ( fig. 1). The left ventriculography (LV) showed severe hypokinesis in the apical wall and mild hypokinesis in the other walls. The pressures in the left ventricle (LV) and aorta (Ao) were: LV = 120/ 15mmHg; Ao = 120/60mmHg.After the procedure, the patient was sent to the intensive care unit (ICU) in stable condition without complaints. The vascular sheaths were maintained. The patient was considered for surgery; routine evaluation, and a presurgical workup were required.Approximately one hour after the admission to the ICU, the patient started feeling oppressive substernal chest pain radiating for the back followed by dyspnea and profuse sweating. The ...
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