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The Radial Artery: An Applicable Approach to Complex Coronary Angioplasty
Lotan1, Hasin, Salmoirago
1Cardiology Department, Hadassah University Hospital, P.O. Box 12000, Jerusalem, Israel, 91120.
Insights
The transradial approach (TRA) for coronary angioplasty is safe and effective, even for complex cases. This study found a high success rate with minimal vascular complications, demonstrating TRA
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- The transradial approach (TRA) is an alternative to the transfemoral approach for percutaneous coronary interventions.
- Assessing the clinical utility and safety of TRA in a real-world setting is crucial for widespread adoption.
Purpose of the Study:
- To evaluate the clinical value and safety of the transradial approach (TRA) in performing coronary angioplasty.
- To determine the success rates and complication profile of TRA in a cohort of patients undergoing coronary interventions.
Main Methods:
- Prospective study of 250 patients undergoing coronary angioplasty via TRA over 18 months.
- Data collection included procedural success, complication rates (major and local vascular), and patient outcomes.
- Analysis of patient demographics, lesion complexity, and additional procedures performed (stenting, rotational ablation).
Main Results:
- High angiographic success rate of 97% with no reported deaths.
- Low rates of major procedural complications (0.8% Q-wave MI, 2.0% non-Q-wave MI, 0.8% urgent CABG, 0.8% CVA).
- Minimal local vascular complications (0.4% compartment syndrome, 1.6% pseudo-aneurysm), with 93% maintaining palpable radial pulse at discharge.
Conclusions:
- The transradial approach (TRA) is a safe and effective method for performing complex coronary angioplasty.
- TRA is associated with a low incidence of vascular complications, making it a valuable alternative to the transfemoral approach.
- No patient experienced hand ischemia, highlighting the safety profile of TRA for limb perfusion.
Abstract:
The purpose of this study was to assess the clinical value of the transradial approach (TRA) in coronary angioplasty. During the 18Ðmonth period from June 1994 to December 1995, 250 patients (mean age 61 +/- 11) underwent coronary angioplasty using the transradial approach. In 7 (2.8%) radial puncture was unsuccessful and in 6 (2.4%) additional femoral access was needed to complete the procedure. Ninety patients (36%) had angioplasty of two or three vessels and 49.5% had type B2 or C lesions. Sixty-five patients (22%) had additional procedures: stent implantations in 50 (16%) and rotational ablation in 15 (6%). Angiographic success was 97% and there were no deaths. Major procedural complications included: Q-wave myocardial infarction in 2 (0.8%), non-Q-wave myocardial infarction in 5 (2.0%), urgent coronary artery bypass grafting in 2 (0.8%) and CVA in 2 (0.8%). Local vascular complication included: compartment syndrome necessitating fasciotomy in 1 patient (0.4%), mild hematoma in 6 (2.4%) and a small pseudo-aneurysm treated by local compression in 4 (1.6%). Radial pulse was palpated in 93% before discharge and in 3% adequate flow could be heard with Doppler. No patient suffered from ischemia of the hand. Complex coronary angioplasty can be performed safely using the TRA with few vascular complications.