Safety and Feasibility of Distal Radial Balloon Aortic Valvuloplasty

Achim, Alexandru; Szűcsborus, Tamás; Sasi, Viktor; Nagy, Ferenc; Jambrik, Zoltán; Nemes, Attila; Varga, Albert; Homorodean, Călin; Bertrand, Olivier; Ruzsa, Zoltán

doi:10.1016/j.jcin.2021.12.029

Cited by 17 publications

(17 citation statements)

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“…Such diffuse changes are most common in end-stage kidney disease. Our center is a dedicated ultrasound-assisted distal radial access center, having switched to this approach since 2019 [ 10 – 12 ]. Duplex US was used in the operating room to investigate all forearm arteries.…”

Section: Discussionmentioning

confidence: 99%

“…From December 2020 to May 2021, 202 consecutive patients who underwent coronary angiography and who required radial Doppler ultrasound examination were recruited in the study. All patients from this period who came to our catheterization laboratory for various transcatheter procedures were included, in the context in which they received standardized pre- and postoperative RUS evaluation of the radial artery [ 10 – 12 ]; the only inclusion criterion was therefore the invasive cardiovascular evaluation, where the ultrasound images were clear, conclusive, and could be noted retrospectively. Design of the study is presented in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

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Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Achim

Kákonyi

Nagy

et al. 2022

Cardiology Research and Practice

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Background. Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods. This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results. A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p = 0.001 ). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p = 0.02 ). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion. RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Achim

Kákonyi

Nagy

et al. 2022

Cardiology Research and Practice

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“…The planning of the procedure by means of pre- and peri-procedural ultrasound certainly helped in this regard. Thus, our data provide further insight into the impressive versatility of the radial artery wall, which can accommodate devices larger than the nominal size regardless of age, body weight and vessel anatomy ( 7 , 26 , 27 ).…”

Section: Discussionmentioning

confidence: 74%

“…Vascular access-site complications (DRA-related) or MACEs were not recorded. The cohort of Lin et al ( 7 ) was larger (298 patients) and, also often used the Glidesheath system in the majority of their patients (95.5%). The investigators observed low vascular complications rates (RAO 0.5%, large hematomas 0.2%), consistent with our data and those by Gasparini et al ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Distal radial access (DRA), a technique that can no longer be called “novel” in terms of its widespread adoption, has already been declared feasible and safe in various types of coronary, structural and peripheral procedures ( 1 – 7 ). The most notable advantages are the low rate of radial artery occlusion, few local complications, short hemostasis time and better ergonomics, both for the patient and for the operator ( 1 , 2 ), especially in the case of left radial artery access.…”

Section: Introductionmentioning

confidence: 99%

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Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Achim

Szigethy

Olajos

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDistal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.MethodsFrom 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).ResultsA total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm2 vs. 1,300 mGy×cm2, p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35).ConclusionUsing DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.

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First application of the distal radial approach for severe mechanical surgical aortic valve paravalvular leak transcatheter closure with a double vascular plug: a case report

Sasi,

Fontos,

Kormányos

et al. 2024

European Heart Journal - Case Reports

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Background Severe aortic paravalvular leaks (PVL) after surgical mechanical aortic valve replacement (AVR) represent high risk for congestive heart failure, haemolysis and infective endocarditis. This is the first case of distal radial artery (DRA) access use for severe mechanical aortic paravalvular leak closure with sequential double vascular plug guided by computed tomography angiography (CTA), transoesophageal echocardiography (TOE) and 3D TOE in acute setting. Case summary A 51-year old male presented with significant mixed aortic valve disease. According to guidelines AVR was performed (Slimline Bicarbon A-25mm). Four and 16 days later re-exploration was carried out due to pericardial effusion. Four months after discharge from rehabilitation the patient was readmitted due to worsening dyspnoea on exertion, then at rest. Transthoracic echocardiography (TTE), TOE and consequently CTA revealed severe PVL. Transcatheter PVL closure was opted. DRA access was preferred. After CTA scan analysis, angiographic, TOE and 3D TOE visualization of the leak a 14/5mm and a 10/5mm vascular plug (AVPIII) was deployed to achieve good result. 9-month clinical, echocardiographic and CTA follow up revealed good long term result. Discussion For transcatheter PVL closure CTA is helpful with not only vascular access planning, but visualization of the leak size, location and device planning. This case demonstrates that the distal radial approach is feasible in cases of severe mechanical aortic valve PVL retrograde transcatheter closure. DRA access could possibly represent less bleeding and vascular access site complications when compared with femoral access and has some potential advantages over regular radial access.

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Safety and Feasibility of Distal Radial Balloon Aortic Valvuloplasty

Cited by 17 publications

References 1 publication

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

First application of the distal radial approach for severe mechanical surgical aortic valve paravalvular leak transcatheter closure with a double vascular plug: a case report

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