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Coronary angiography from the radial artery--experience, complications and limitations
D J Hildick-Smith1, M D Lowe, J T Walsh
1Department of Cardiology, Papworth Hospital, Cambridgeshire, UK.
Insights
Coronary angiography via radial artery puncture is feasible in high-risk patients, particularly those with contraindications to the femoral approach. However, limitations include a learning curve and potential vascular complications.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- Percutaneous coronary angiography is a key diagnostic tool.
- The radial artery approach offers an alternative to the traditional femoral artery route.
- Assessing the radial approach in high-risk populations is crucial for expanding its utility.
Purpose of the Study:
- To evaluate the outcomes, complications, and limitations of coronary angiography performed via percutaneous radial artery puncture.
- To determine the success rate and safety profile of the radial approach in patients unsuitable for femoral access.
Main Methods:
- A prospective study involving 250 patients undergoing diagnostic coronary angiography.
- Radial artery puncture was utilized, especially in patients with contraindications to the femoral approach (e.g., peripheral vascular disease, anticoagulation).
- Procedural success, duration, fluoroscopy time, and complication rates were recorded and analyzed.
Main Results:
- Procedural success was achieved in 92.4% of high-risk patients.
- The radial approach was necessary for 72.8% of patients due to contraindications to the femoral route.
- Complications included two deaths, three arterial dissections, and one transient ischemic attack.
Conclusions:
- Coronary angiography via the radial artery is a viable option, particularly when femoral access is contraindicated.
- Limitations include a learning curve, potential for arterial spasm, patient discomfort, and vascular complications.
- The study suggests reserving radial angiography for cases with contraindications to the femoral approach.
Aims:
to assess the outcomes, complications and limitations of coronary angiography performed via percutaneous radial artery puncture.
Methods And Results:
two hundred and fifty patients underwent diagnostic coronary angiography from the radial artery, 182 (72.8%) of whom had contraindications to the femoral approach, for example due to peripheral vascular disease (n=85), therapeutic anticoagulation (29), or failed femoral approach (17). Procedural success in this high-risk population was achieved in 231 patients (92.4%). Principle reasons for failure were unsuccessful radial access (5) and arterial spasm (5). Procedure duration (SD) for an operator's first 20 cases compared with cases thereafter (min) was 47.7 (16.7) vs. 41.5 (14.6), P=0.0004; fluoroscopy time (min) 9.7 (7.1) vs. 6.6 (5.1), P=0.0001 and procedural success 89.6% vs. 94.1%, P=ns. Complications included two deaths associated temporally with catheterisation, three cases of arterial dissection without ischaemic sequelae and one transient ischaemic attack.
Conclusions:
coronary angiography can be performed successfully from the radial artery, but this approach has limitations, which include the need to demonstrate dual palmar vascular supply, the prolonged learning phase, the procedural failure rate, patient discomfort and a demonstrable incidence of vascular and haemodynamic complications. We believe that radial coronary angiography should only be undertaken when there is a contraindication to the femoral approach.