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Published on: September 20, 2020
Current alternatives to traditional radial approach for coronary interventions: A randomized prospective study of the
Moustafa Elwany1, Moustafa Dawood1, Alaa Shakhlab1
1Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Ulnar artery access is a superior alternative to distal radial artery access for coronary interventions, offering higher success rates and shorter cannulation times. Both approaches provide viable alternatives to traditional radial artery access.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- The radial artery is the primary access site for coronary interventions.
- Alternative access sites are crucial for patients undergoing coronary artery bypass grafting or requiring dialysis fistulas.
- Ulnar and distal radial artery accesses are emerging as alternatives to traditional radial artery access.
Purpose of the Study:
- To compare the safety, efficacy, and success rates of distal radial artery access versus ulnar artery access.
- To evaluate these as alternatives to traditional radial artery access for coronary interventions.
Main Methods:
- A study involving 200 patients: 100 traditional radial (TRA), 50 distal radial (DRA), and 50 ulnar artery access.
- Follow-up ultrasound of the access artery was conducted up to 28 days post-procedure.
Main Results:
- Procedural success rates were 97% (TRA), 74% (DRA), and 92% (ulnar).
- Crossover rates due to cannulation failure were 3% (TRA), 26% (DRA), and 8% (ulnar).
- Mean cannulation times were 80.19s (TRA), 148.4s (DRA), and 90.5s (ulnar).
Conclusions:
- Distal radial and ulnar artery accesses are potential alternatives to the traditional radial approach.
- Ulnar artery access demonstrated superiority over distal radial artery access in terms of success rate and cannulation time.
Background:
The radial artery is the standard access for coronary intervention; however, it is essential to have alternative accesses as it may be used as a conduit during coronary artery bypass grafting or for dialysis fistula. Ulnar and distal radial artery accesses have emerged as alternative accesses for traditional radial artery.
Aim:
To compare distal radial artery access and ulnar artery access as alternatives to traditional radial artery access regarding safety, efficacy, and success rate.
Methods:
Two-hundred patients were included (100 traditional radial [TRA], 50 distal radial [DRA] and 50 ulnar). Access artery follow up ultrasound was performed up to 28 days.
Results:
Procedural success rate was 97%, 74%, and 92% in the TRA, DRA and ulnar groups, respectively (p < 0.001). Crossover occurred in 3 patients (3%) in TRA, 13 patients (26%) in DRA and 4 cases (8%) in ulnar group (p < 0.001). The most common cause of crossover was failure of artery cannulation. Regarding cannulation time, the mean access time in seconds was 80.19 ± 25.98, 148.4 ± 29.60, 90.5 ± 21.84 in TRA, DRA and ulnar groups, respectively (p < 0.001).
Conclusions:
Our study concluded that these new approaches proved to be potential alternatives to traditional radial approach; however, ulnar artery access proved to be superior to distal radial artery access as regards success rate and cannulation time.
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation