Radial Artery Catheterization for Percutaneous Vascular or Coronary Interventions: An Innocent Procedure?

Paraskevas, Kosmas I.; Anastasakis, Eleftherios; Andrikopoulou, Maria; Mikhailidis, Dimitri P.

doi:10.1177/0003319709353169

Cited by 14 publications

(18 citation statements)

References 31 publications

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“…There has been an increasing worldwide adoption of transradial (TR) coronary procedures based on the marked reduction in access-site complications compared with transfemoral (TF) access. 1,2 This evolution trend has emerged because interventionalists wish to provide a less risky albeit technically more challenging procedure, and the patients appear to prefer the convenience of TR access.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

et al. 2018

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Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be appropriate anticoagulation" for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.

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Section: Introductionmentioning

confidence: 99%

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

et al. 2018

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“…18 Injury of the RA during the catheterization may lead to irreversible functional and structural damage. 19,20 Several studies found reduction in nitroglycerin-mediated dilation, long-term thickening, and marked narrowing of the artery after transradial catheterization. [21][22][23] Surgeons often overlook the fact that the RA has become a common site of cannulation and therefore exposed to injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies indicated that preexisting arterial wall disease and preoperative RA trauma affect conduit functioning after implantation, an angiographic follow-up would have helped in confirming the importance of our approach. 15,[17][18][19][20][21][22][23]…”

Section: Discussionmentioning

confidence: 99%

Preoperative Insight Into the Quality of Radial Artery Grafts

et al. 2017

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We investigated the impact of preoperative ultrasonography of the forearm circulation on radial artery conduit selection. Preoperative ultrasound of the forearm circulation was performed routinely in 536 patients planned for radial artery harvesting. The safety assessment of the harvest included the following algorithm of tests: the ultrasound, the Allen test, and pulse oximetry. The quality criteria that were used to exclude a radial artery from harvesting were small size of the artery, diffuse atherosclerosis, calcifications, and severe neointimal hyperplasia. The overall rejection rate due to safety reasons was 16.4%. Seventy-one (13.2%) radial arteries did not fulfill the conduit quality criteria and consequently these arteries were not harvested. In 13.4% of radial arteries, localized arterial wall disease was found in the distal third of the artery. The distal part of the artery was discarded and the rest was used as a conduit. Our results indicate that the ultrasound provides an accurate preoperative insight into the radial artery morphology, enabling selection of the arteries with favorable morphological features.

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“…An additional limitation is that they did not report the prevalence of transradial PCI. Despite the possibility that TRI may limit the use of a radial artery as a conduit for CABG, 19,20 previous studies suggest that TRI was superior to transfemoral access in reducing bleeding and vascular complications; this may influence clinical outcome, especially, in patients presenting with ACS. [9][10][11] Our study compared TRI with DES versus CABG for UPLM and/or MVD and found no significant difference in composite outcome (death/MI/ stroke) between TRI and CABG.…”

Section: Discussionmentioning

confidence: 99%

Transradial Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main and/or Multivessel Disease in Patients With Acute Coronary Syndrome

et al. 2015

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The overall safety and efficacy of transradial coronary intervention (TRI) versus coronary artery bypass grafting (CABG) for patients with unprotected left main (UPLM) disease and/or multivessel coronary disease (MVD) presenting with acute coronary syndrome (ACS) have not been established. Consecutive patients with ACS undergoing TRI with drug-eluting stent (n ¼ 1431) or CABG (n ¼ 651) for UPLM and/or MVD were included. A propensity-score matching was performed to adjust for differences in baseline characteristics between the 2 cohorts, yielding 524 pairs of matched patients. Median clinical follow-up was 32 months. After propensity-score adjustment, no significant difference was observed between the TRI and CABG groups in all-cause mortality (4.0% vs 5.2%; P ¼ .375). Transradial coronary intervention was favored by a significant increase in the incidence of stroke in the CABG group (0.4% vs 1.9%; P ¼ .020), whereas a significantly increased target vessel revascularization rate (16.8% vs 6.3%; P < .0001) observed in the TRI group favored CABG. Composite outcome (death/myocardial infarction/ stroke) was comparable between the TRI and the CABG groups (8.0% vs 11.5%; P ¼ .061). Clinical outcomes of TRI on UPLM and/or MVD for patients with ACS are comparable to CABG in composite safety outcomes with the advantage to TRI for avoiding a stroke.

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Radial Artery Catheterization for Percutaneous Vascular or Coronary Interventions: An Innocent Procedure?

Cited by 14 publications

References 31 publications

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

Preoperative Insight Into the Quality of Radial Artery Grafts

Transradial Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main and/or Multivessel Disease in Patients With Acute Coronary Syndrome

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