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Percutaneous transradial artery approach for coronary Palmaz-Schatz stent implantation
1Amsterdam Department of Interventional Cardiology-OLVG, The Netherlands.
Insights
This study demonstrates that implanting Palmaz-Schatz coronary stents via the radial artery is feasible and safe. This transradial approach reduces vascular complications associated with femoral artery access, improving patient recovery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Femoral artery access for coronary stenting increases risks of vascular complications and prolonged hospitalization.
- Large-bore guiding catheters used in femoral access can lead to suboptimal anticoagulation and local sequelae.
- The radial artery offers a smaller vessel access site with easier hemostasis and minimal risk to nearby nerves and veins.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of implanting unsheathed Palmaz-Schatz coronary stents.
- To evaluate the transradial artery approach as an alternative to femoral access for coronary stenting.
Main Methods:
- Twenty-five Palmaz-Schatz stents were implanted in 20 patients using 6F guiding catheters via the radial artery.
- Indications included venous bypass graft stenosis, native coronary artery restenosis, and suboptimal transradial artery percutaneous transluminal coronary angioplasty.
- Post-procedure assessment included quantitative coronary analysis and ultrasound evaluation of radial artery function and anatomy.
Main Results:
- The transradial approach was successfully used for stent implantation in all patients.
- Radial artery occlusion was well-tolerated due to the dual blood supply to the hand.
- No major puncture site-related complications were reported, with easy hemostasis achieved.
Conclusions:
- Transradial implantation of Palmaz-Schatz coronary stents is a feasible, safe, and effective alternative to femoral access.
- This approach minimizes vascular complications and allows for early patient ambulation.
- The radial artery is a suitable access site for coronary stenting, even with unsheathed stents.
Abstract:
The purpose of this study was to evaluate feasibility, safety, and efficacy of implantation of unsheathed Palmaz-Schatz coronary stents via the radial artery. Anticoagulation after coronary stenting has the hazard of vascular complications if large-bore guiding catheters are introduced via the femoral artery. Such complications have serious local sequelae, are associated with suboptimal anticoagulation, and prolong hospitalization. By combining 6F guiding catheters and low-profile dilatation catheters with bare Palmaz-Schatz stents, smaller vessels such as the radial artery can be selected as the entry site. It is postulated that no major puncture site-related complications occur because hemostasis is easily achieved and no veins and nerves are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. Twenty-five bare Palmaz-Schatz stents were implanted via the radial artery through 6F guiding catheters in 20 consecutive patients for venous bypass graft stenosis (n = 9; 45%), native coronary artery restenosis (n = 7; 35%) and suboptimal transradial artery PTCA (n = 4; 20%). Immediately after stent implantation and assessment of the result by means of computerized quantitative coronary analysis, the arterial sheath was withdrawn followed by intense anticoagulation and free ambulation of the patient. Radial artery function and anatomy were assessed by two-dimensional and Doppler ultrasound examination. Lesions (n = 24) were of type A (n = 13; 54%), B (n = 6; 25%) and C (n = 5; 21%). The reference diameter of the stented segments was 3.2 +/- 0.5 mm (2.2 to 4.2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)