Ipsilateral transulnar artery approach catheterizations after failure of the radial approach—Are two sheaths in the same arm safe?

Zafirovska, Biljana; Jovkovski, Aleksandar; Vasilev, I; Taravari, Hajber; Kitanoski, Darko; Petkoska, Danica; Paljoskovska, Savetka; Kostov, Jorgo; Ho, Kalon K.L.; Kedev, Saško

doi:10.1002/ccd.29778

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…In this study wrist access was used in all procedures, with TUA with ipsilateral RAO being used in 10% of patients without major vascular or ischemic complications documented at follow‐up. Since we can testify to a decade long experience with this access site and previously published studies from our center, 35,36 our opinion is that this alternative access site is the most advantageous in preserving wrist access benefits without sacrificing safety or procedural success. Nevertheless, further studies are needed to affirm this access as an alternative to TRA in the recommendations.…”

Section: Discussionmentioning

confidence: 91%

Radial and ulnar approach for carotid artery stenting with Roadsaver™ double layer micromesh stent: Early and long‐term follow‐up

Petkoska

Zafirovska

Vasilev

et al. 2022

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 91%

Radial and ulnar approach for carotid artery stenting with Roadsaver™ double layer micromesh stent: Early and long‐term follow‐up

Petkoska

Zafirovska

Vasilev

et al. 2022

Cathet Cardio Intervent

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“…In this prospective study, we examine the influence of gender in patients at high risk for endarterectomy, on the safety and success of carotid stenting performed through radial approach. All procedures in our study were successfully performed using right radial approach without switching to femoral, although it is important to note that our center is an experienced radial center where 99% of all procedures are performed using wrist approach [12], [26], [27]. Postoperative adverse events in women compared to men had no significant differences in the rate of stroke, MI, and mortality.…”

Section: Discussionmentioning

confidence: 92%

Gender Differences in High-risk CAS through Radial Access

Petkoska

Zafirovska

Paljoskovska-Jordanova

et al. 2023

SEE J Cardiol

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AIMS: Transradial (TR) carotid artery stenting (CAS) has been established as an acceptable alternative to carotid endarterectomy, especially in patients with a high risk for surgery. The purpose of this study was to evaluate the gender differences of radial access CAS in high-risk patients. MATERIALS AND METHODS: This was a prospective analysis which included 54 consecutive patients in the period from December 2020 to January 2022. According to the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy study for high-risk CAS, patients with at least one anatomic or comorbid factor associated with increased surgical risk were included in the study. Subjects were divided into two groups according to sex. Follow-up assessments included neurological exams, 12-lead electrocardiogram, and duplex ultrasound (DUS). The primary endpoint was 30-day composite rate of stroke, death, and myocardial infarction. Secondary endpoints included procedure success, access site complications according to Early Discharge after TR Stenting of Coronary Arteries (EASY) score classification, target lesion revascularization, and in-stent restenosis evaluated with DUS. RESULTS: The study population was predominantly male 37 (61.1%) and females were 17 (38.9%). Mean age in the women group was 64.4 ± 7.43 years, and in men, it was 69.1 ± 8.01 years (p = 0.0223). From risk factors for coronary artery disease, hypertension and smoking were more frequent in the male group and hyperlipidemia and diabetes in the female group. Most of the male patients were symptomatic compared to the female group (p = 0.0151). Procedural success was obtained in all cases. Transient vasospasm induced by the distal protection device was present in one male patient. No 30-day major adverse events were recorded between the two groups. Minor access site bleeding complications according to EASY score (Easy type 1) were recorded in 4 patients (3 males vs. 1 female). There were no cases of hand ischemia after procedure or follow-up. None of the patients had in-stent restenosis >70% on DUS during 1-year follow-up. CONCLUSION: Results from this study demonstrate no gender-related differences in radial access CAS for high-risk patients.

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“…Furthermore, it is important to note that transulnar access, like radial access, has the same benefits as a wrist puncture site. It reduces procedural time in primary PCI, saves the contralateral RA for future possible coronary artery bypass grafting and avoids the use of femoral access in all patients scheduled for PCI [22], [23]. We consider this access as the best alternative for right radial access even in the presence of RAO, with long-time experience of over 12 years in our center.…”

Section: Discussionmentioning

confidence: 96%

“…Despite its proven advantages, certain characteristics of radial approach as the common occurrence of RAO, particularly when reusing this access site, are worth additional research for alternatives, intervention or even better, decreasing the number of this not so rare complication of TRA. Published studies about crossing over to other wrist access sites as the iplsilateral ulnar have proven to be safe and successful in preserving the benefits of radial access [22], [23]. Still, radial operators must try to conserve the patency of the RA and implement all available data on this topic to protect the RA from occlusion as an integral part of their practice.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures

et al. 2022

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AIM: The purpose of the study was to present a new technique of retrograde recanalization of radial artery (RA) occlusion (RAO) in patients with need for repeated wrist access percutaneous angiographic procedures. MATERIALS AND METHODS: During a 10-year period from March 2011–May 2021, 53 000 patients were referred for percutaneous coronary intervention (PCI) in a high-volume transradial center. RAO on angiography was documented in 1165 patients. Retrograde recanalization of RAO was attempted in 70 patients. The selected patients were with multiple previous bilateral wrist interventions (n = 3–9). Ipsilateral ulnar artery was usually rudimented or occluded and contralateral wrist approach could not be used. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and procedural success of retrograde recanalization of RAO. Visual analog scale (VAS) score forearm pain assessment was performed after procedure. Technique: All patients had palpable pulse distal of previous puncture site due to collaterals from ipsilateral ulnar and interosseous artery. The RA was punctured with an inner metallic needle with a plastic cannula. Using retrograde radial angiography performed by injecting contrast through the plastic cannula, the occluded segment was visualized and crossed with different types of hydrophilic chronic total occlusion guide wires. After sheath insertion, balloon dilatation of the occluded RA segment, successful catheterization, and/or percutaneous coronary intervention was performed. Final RA angiography was performed on all patients. RESULTS: Successful retrograde opening of RAO was achieved in 65 out of 70 patients (92%). PCI was performed in 56% of patients through the opened RAO and 5 patients underwent CAS. Procedural success through opened RA was achieved in all 65 patients. Forearm pain during procedure was present in all cases (VAS score 3 ± 2.1). Access site bleeding EASY score 3 and 4 occurred in 6 patients (8.5%). One patient had discharge of embolic material up the arm without clinical consequences. In one patient, we observed dissection of the interosseous artery. Clinical and duplex long-term follow-up with a median of 4.1 years showed patent RA in only 20 patients. There were no registered cases of hand ischemia. About 61% of patients underwent subsequent PCIs, through other alternative access sites. CONCLUSION: Retrograde recanalization of RAO is successful and safe in patients with need of repeated coronary angiography procedures and inability to use other wrist access sites. Puncturing the collateral and performing retrograde radial angiography through the cannula is a key factor in successful opening of the RAO.

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Ipsilateral transulnar artery approach catheterizations after failure of the radial approach—Are two sheaths in the same arm safe?

Cited by 6 publications

References 33 publications

Radial and ulnar approach for carotid artery stenting with Roadsaver™ double layer micromesh stent: Early and long‐term follow‐up

Radial and ulnar approach for carotid artery stenting with Roadsaver™ double layer micromesh stent: Early and long‐term follow‐up

Gender Differences in High-risk CAS through Radial Access

Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures

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