[Percutaneous radial approach for coronary angiography]

The Sones technique for coronary angiography has been abandoned by most of laboratories. Nevertheless, in some circumstances (anticoagulation, peripheral arteriopathy, outpatients procedures), the femoral entry site may be troublesome. We evaluated the feasibility and safety of percutaneous transradial approach to coronary angiography as an alternative way to the usual femoral approach.

Since July to october 1995 we performed 200 consecutive coronary angiographies via radial artery with percutaneous approach. Exclusion criteria were the absence of radial pulse, abnormal Allen test and the need to perform right catheterism. No patient was excluded because of age or other clinical reason. We used right radial artery in 192 cases, left radial artery in 7 cases and both right and left artery in 7 cases. Thirteen patients (6.5%) had previous CABG. Thirteen patients were under treatment with heparin or dicoumarol. Twenty-one patients (10.5%) were affected by lower extremities arteriopathy. Five patients had previous coronary angiography by Sones technique. Fifty-eight patients (29%) underwent coronary angiography on outpatient basis. We used 6 F catheters in all cases but one. 5000 UI heparin bolus was injected in all cases. Sheaths were pull-out immediately after the procedure. We used Judkins L 3.5 and Judkins R 4 as first choice catheter.

We succeeded in performing a complete coronary angiography in 189 patients (94.5%). In 11 patients the angiography had to be performed or completed by femoral approach: we failed in radial artery puncture in 5 patients; in 2 patients the guidewire could not be advanced beyond brachial bifurcation; in 1 very tall patient the catheter distal extremity did not reach coronary ostia; in 1 case were not able to do selective injection in left coronary ostium because of brachiocephalic trunk tortuosity; in 2 patients resistant radial artery spasm occurred. It was necessary to change the first choice catheter in 17 patients (8.5%) for left coronary artery and in 4 patients (2%) for right coronary artery. Clinical complications were ventricular fibrillation in 1 case and vasovagal reaction in 3 cases. Local complications were mild haematic effusion in 5 cases, small haematomas in 2 cases. In 12 patients radial artery pulsations were not palpable at discharge; in 4 of them radial artery pulse spontaneously reappeared after a week.

Percutaneous transradial approach for coronary angiography is safe and feasible and represents a good alternative entry method mainly in patients with peripheral arteriopathy, in patients treated with anticoagulants and in outpatients coronary angiography.