Feasibility limits of transradial primary percutaneous coronary intervention in acute myocardial infarction in the real life (TRAP-AMI)

Abstract

In STEMI patients without cardiogenic shock and without a priori indication for TFI, PCI can be performed via the radial artery in more than 90% of cases with high procedural success rate. Operator's judgement of eligibility for TRI based on radial pulse quality is predictive of successful TRI in 95% of cases. TR failure is significantly more common in the elderly and in patients with low body weight.

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

“…Mamas et al [16] recently reported data on the nationwide practice of PCI in the UK, showing highly variable rates of radial approach use between centres, with an overall rate of use of only 26%. The feasibility of PCI by radial access is clearly lower than the 90% recently described in a 'real-life' population of uncomplicated ST-elevation MI [18]. Indeed, CS is a strong independent predictor of transradial approach PCI failure [19].…”

Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention

“…Crossover from TRA to TFA in primary PCI for STEMI in recent studies has been reported to range from 3.7% to 9.6% 13 14 28 29. However, current real world data on predictors of TRA-PCI failure in the STEMI population are very scarce, and limited to selected cohorts 19 20…”

“…Some retrospective studies reporting on TRA failure rate and predictors were limited by heterogeneity of patients, in addition to overall TRA volume,18 while others were selective, and excluded patients presenting with cardiogenic shock complicating STEMI 19 20 29. Vink et al 19 recently examined the feasibility of routine TRA in primary PCI (excluding cardiogenic shock) in a single centre where TRA was the default for >10 years.…”

Delayed onset of forearm compartment syndrome after transradial percutaneous coronary intervention

“…Percutaneous coronary intervention (PCI) performed via the transradial approach is associated with a lower risk of major vascular complications and a lower risk of major bleeding at the access site than PCI via the transfemoral approach in patients with acute coronary syndrome [2,3] and in patients with acute ST-segment elevation who require primary coronary intervention and aggressive antithrombotic treatment [4,5]. Nevertheless, bleeding at the radial access site can lead to forearm hematoma and rarely, to compartment syndrome [6].…”

“…The possible reasons for delayed onset of the syndrome in our patient include radial artery atherosclerosis with inadequate contraction after hemostatic band compression and overdose of unfractionated heparin (640 units/h). Studies have shown that compartment syndrome after transradial coronary intervention is rare (b 0.01%) [7] but tends to be more common in the elderly with low body weight [5]. Activated partial thromboplastin time/activated clotting International Journal of Cardiology 178 (2015) 77-78 time and the condition of the vascular access site should be closely monitored to prevent compartment syndrome.…”