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Usefulness of rescue ultrasound guidance for transradial cardiac catheterization
Manabu Kashiwagi1, Takashi Tanimoto1, Hironori Kitabata1
1Department of Cardiology, Shingu Municipal Medical Center, Japan.
Insights
Ultrasound guidance (UG) significantly improves transradial cardiac catheterization success rates, despite slightly longer procedure times. This technique enhances sheath insertion, making it a valuable tool for interventional cardiologists.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Transradial cardiac catheterization offers patient comfort and fewer access site complications compared to transfemoral approach.
- However, the transradial approach has a higher failure rate than the transfemoral method.
- Ultrasound guidance (UG) is explored as a method to improve transradial success rates.
Purpose of the Study:
- To evaluate the effectiveness of ultrasound-guided rescue in facilitating transradial cardiac catheterization.
- To compare the outcomes of transradial cardiac catheterization using palpation technique versus ultrasound guidance.
Main Methods:
- Retrospective analysis of 592 patients undergoing coronary angiography or percutaneous coronary intervention.
- Patients were divided into palpation technique (PT) and ultrasound guidance (UG) available groups.
- Ultrasound guidance was used at operators' discretion in a subset of the UG group.
Main Results:
- The success rate of sheath insertion was significantly higher in the UG group (97%) compared to the PT group (92%).
- No significant difference in hematoma incidence was observed between the groups (6.8% vs. 5.8%).
- Multivariate analysis identified UG availability as the sole independent predictor of successful sheath insertion (OR 2.79).
Conclusions:
- Ultrasound-guided rescue is effective for achieving successful transradial cardiac catheterization.
- Despite requiring additional setup time, UG enhances procedural success.
- This technique represents a valuable advancement for transradial interventions.
Introduction And Objectives:
Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization.
Methods:
We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n = 280) and the ultrasound guidance (UG) available group (n = 312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators.
Results:
Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p = 0.62). Although the procedural time in the UG group was longer than that in the PT group (303 s vs. 357 s, p < 0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p < 0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24-6.31, p = 0.01).
Conclusions:
Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization.
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