Anatomical obstacles and their impact on the sheath to balloon time while intervening through a trans-radial approach in patients undergoing primary percutaneous coronary intervention

Abstract

Funding Acknowledgements Type of funding sources: None. Background Trans-radial approach has been considered a safe and useful vascular access site for cardiac catheterization in comparison with the conventional trans-femoral approach. However, radial access has many challenges, such as access difficulty related to anatomical variations, radial artery spasm, occlusion, loops, tortuosities, and aberrant origin of radial and subclavian arteries. These factors were ignored in the large randomized trials that might have a significant impact on the outcome. Purpose To determine the predictors of anatomical obstacles and their impact on the sheath to balloon time while intervening through a trans-radial approach in patients undergoing primary percutaneous coronary intervention. Methods This was a case-control study comprised of 466 patients who underwent primary percutaneous coronary intervention to determine the predictors of anatomical obstacles including radial artery spasm, radioulnar loops, aberrant radial artery, tortuous configuration, and subclavian tortuosity. Sheath to balloon time was determined in both the groups with and without anatomical obstacles. Results Patients with and without anatomical obstacles were recruited in a 1:3 ratio. Female gender was found to be associated with anatomical obstacles with the distribution of 28.6% (32/112) vs. 19.2% (68/354); p = 0.035 for the patients with and without anatomical obstacles. Patients with obstacles were comparatively older than patients without obstacles with the mean age of 59.11 ± 8.86 vs. 55.6 ± 9.45 years; p < 0.001. Diabetes as co-morbid was another clinical factor observed to be associated with the presence of anatomical obstacles with the distribution of 50.9% (57/112) vs. 40.1% (142/354); p = 0.044 for with and without obstacles cohort respectively. Among patients with anatomical obstacles, the most common type of obstacle was observed to be subclavian tortuosity (40.2%) followed by radial artery spasm (25.9%), tortuous configuration (17.0%), radioulnar loop (12.5%), and abnormal origin of the RA (4.5%). A significantly higher sheath to balloon time was observed for the patients with anatomical obstacles as compared to those without with a mean duration of 30.92 ± 13.25 vs. 19.42 ± 6.2 minutes; p < 0.001. Conclusion Older age, female gender, and diabetes were found to be the major predictors for anatomical obstacles and hence significantly increasing the sheath to balloon time. Moreover, Subclavian tortuosity was the most common obstacle followed by the radial artery spasm. Therefore, predicting the factors prolonging the procedure time could be beneficial to select the access site and can improve the overall outcome.