Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures

Sgueglia, Gregory A.; Giorgio, Angela Di; Gaspardone, Achille; Бабунашвили, А. М.

doi:10.1016/j.jcin.2018.04.045

Cited by 133 publications

(139 citation statements)

References 30 publications

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“…Data on the use of the dRA approach for endovascular procedures are currently still limited in the interventional cardiology and neurointerventional literature,12 but available studies suggest that dRA access has additional advantages over the standard transradial access such as decreased rates of dRA occlusion and theoretically fewer ischemic events,7–10 significantly shorter post-procedural duration of hemostasis as well as slightly higher patient satisfaction 23. Although critical hand ischemia after transradial access is infrequent, the dRA approach may offer a theoretical advantage of reduced risk for ischemic hand complications as the origin of the superficial palmar branch lies proximal to the anatomical snuffbox access site and antegrade blood flow remains preserved in the event of a dRA injury or occlusion 24 25…”

Section: Discussionmentioning

confidence: 99%

Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

Kühn

Rodrigues

Singh

et al. 2020

J NeuroIntervent Surg

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PurposeTo report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.MethodsA retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.Results48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.ConclusiondRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

Kühn

Rodrigues

Singh

et al. 2020

J NeuroIntervent Surg

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“…Indeed, in a retrospective series, the absence of blood flow during the hemostasis process significantly increased the risk for RAO [6]. On this background, dTRA could maintain forearm radial artery patency during hemostatic compression or in case of occlusion at the puncture site [7].…”

Section: Review Anatomymentioning

confidence: 99%

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Nairoukh¹,

Jahangir²,

Adjepong³

et al. 2020

Cureus

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Access sites for coronary intervention have been changing over the last several decades, from the femoral artery to the radial artery and then to the distal radial artery. Distal radial access, which was first used in 2017 and is still not recommended by the guidelines, shows a higher success rate and less complications than other sites; therefore, it might be the future for cardiovascular intervention. In this study, we reviewed almost all of the articles that are related to the distal radial access, from 2017 to present, and summarized the technique, success rate, advantages, disadvantages, and noncardiac use of this access site.

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“…Given our interest in complex PCI using a five French guiding catheter, we previously verified in an in‐house bench test model that, despite being labeled six French‐compatible, the C 2 (Shockwave Medical, Fremont, CA) coronary lithotripsy balloon can be easily advanced and retracted through a five French guiding catheter (Figure , Supporting Information Online Movie Clip S1). To minimize trauma to our patient's small right radial artery, the second transradial access was obtained in the anatomical snuffbox, and a five French ADROIT (Cordis, Mimai Lakes, FL) XB 3.5 curve guiding catheter was inserted sheathless according to the balloon‐assisted tracking technique (Figure ) . The procedure was straightforward, being easily performed with even advancement of the C 2 balloon to the target lesion, shockwave treatment and eventually biodegradable‐polymer drug‐eluting stent implantation.…”

Section: Case Descriptionmentioning

confidence: 99%

Slender distal radial five French coronary shockwave lithotripsy

Sgueglia

Gioffrè

Piccioni

et al. 2019

Cathet Cardio Intervent

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Despite technological evolution, percutaneous coronary interventions targeting coronary calcifications remain challenging and associated with high rates of complications and adverse outcomes. Over the years, rotational atherectomy has emerged as the reference treatment of calcified coronary artery lesions despite some inherent limitations. Also, rotational atherectomy typically requires relatively large guiding catheters which may unfavorably impact on the decision for transradial access, especially when radial artery is small, and consequently offset the relevant clinical benefits associated to transradial access. Recently, a new technology has been introduced in interventional practice to implement coronary lithotripsy. The device implements multiple small emitters enclosed in a coronary balloon creating sonic pressure waves to selectively fracture calcium within the plaque and favorably modify vessel compliance. Owing to its specific design, coronary shockwave lithotripsy could be used with small bore guiding catheters which may allow for straightforward transradial percutaneous treatment of calcified coronary lesions even in patients with a small radial artery. To illustrate this concept, we report the first experience of slender transradial coronary shockwave lithotripsy with a five French sheathless guiding catheter.

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Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures

Cited by 133 publications

References 30 publications

Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Slender distal radial five French coronary shockwave lithotripsy

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