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Compared with the traditional transfemoral approach, the transradial approach (TRA) can be used as a new alternative approach in the diagnosis and treatment of neurointervention, and has more advantages in reducing access site complications, improving the comfort of patients, shortening the length of hospital stay, and reducing the overall medical costs, so it has attracted clinical attention. This article mainly reviews the application of TRA in the field of neurointerventional diagnosis and treatment, as well as its advantages, complications and other aspects, and puts forward its application prospects in the field of neurointerventional diagnosis and treatment, so as to provide reference for the development of this technology in the field of neurointerventional diagnosis and treatment and further research in this field.
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Distal transradial access for vascular interventions has gained ground recently. While the novel approach is associated with reduced radial artery occlusion and faster hemostasis, it could be related with prolonged procedural time, higher crossover rate and increased radiation, comparing to conventional transradial approach. Whether the radiation is increased in the procedures performed by the novel approach remains unambiguous. In the specific article, we aim to review the current literature and to propose possible explanations for this phenomenon. Could radiation be the Achilles’ heel of distal transradial artery access?
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Abstract Objective: The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background: The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods: We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results: We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions: Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.
Resumen Objetivo: Describir la factibilidad del uso de un solo catéter en el intervencionismo coronario percutáneo por vía transradial. Antecedentes: El abordaje transradial en las intervenciones coronarias ha mostrado menores eventos cardiovasculares y complicaciones, y menor mortalidad. Sin embargo, algunos eventos adversos pueden resultar por trotuosidad de las arterias del brazo, curva de aprendizaje más larga o espasmo arterial que puede complicar, retardar o impedir la intervención coronaria. Ésta última es usualmente exacerbada por el intercambio de catéteres o la manipulación de los mismos. Métodos: Realizamos un studio utilizando un solo catéter en pacientes sometidos a coronariografía e intervención coronaria. Los desenlaces del procedimiento incluyendo éxito, tiempo de procedimiento, sangrado, complicaciones en el sitio de acceso y uso de medio de contraste fueron analizados. Resultados: Incluimos 327 pacientes, 70% de los cuales fueron varones. La edad promedio fue de 63.3 ± 11.1 años, la estatura promedio fue de 165.9 ± 7.7 cm, peso promedio de 73.3 ± 11.3 kg y el índice de masa corporal promedio de 26.5 ± 3.5 kg/m2. El contraste utilizado promedio fue 158.5 ± 60.5 ml. El total de vasos tratados fue de tres en 3% de los casos, dos en 32% de los casos y uno en 65%. El éxito del procedimiento fue logrado en 94.5% de los pacientes No obstante, un Segundo catéter fue requerido en 9 intervenciones (2.7%), y cambio en la vía de acceso fue realizado en 9 casos (2.7%) por falta de apoyo, espasmo arterial, anatomía dificil o necesidad de un catéter de mayor lumen. Tres complicaciones asociadas al sitio de acceso incluyendo un hematoma clase 2 fueron registradas el cual se trató conservadoramente. Conclusiones: Nuestro estudio mostró que el uso de un catéter único para realizar tanto procedimientos diagnósticos como terapéuticos tiene una tasa de éxito mayor, con menor incidencia de espasmo y complicaciones reportadas en la literatura.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Disease/surgery , Cardiac Catheterization/methods , Radial Artery , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/methods , Cardiac Catheters , Coronary Artery Disease/pathology , Feasibility StudiesABSTRACT
Objective To evaluate the feasibility and safety of prostatic artery embolization (PAE)via transradial approach in treating prostatic hyperplasia.Methods The clinical data of 18 patients with prostatic hyperplasia,who received C-arm CT-guided PAE via left or right radial artery access,were retrospectively analyzed.The following indexes were recorded:arterial spasm and injury of upper limbs,incidence of puncture point bleeding,postoperative radial artery pulse and congestion,blood supply and nerve injury of fingers,the surgical success rate,incidence of perioperative cerebral vascular complications,operation time,radiation dose and clinical curative effect.Results Among the 18 patients,PAE via left radial artery access was employed in 14,and PAE via right radial artery access was performed in 4.Bilateral PAE was carried out in 16 patients,and only unilateral PAE was able to be successfully accomplished in 2 patients as the prostatic artery opening of the other side was tortuous with stenosis.After PAE,decreased radial pulse was observed in one patient and ultrasound examination revealed decreased blood flow.The operation time ranged from 96 min to 245 min.The radiation dose received by the patient varied from 2435 mGy to 4958 mGy with a mean of (3342±156) mGy,which was not significantly different from the radiation dose received by the patients who underwent PAE via femoral artery access during the same study period (P=0.1167).Conclusion In treating prostatic hyperplasia,PAE by using transradial approach is clinically safe and technically feasible.
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Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.
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Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.
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PURPOSE: The generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses. MATERIALS AND METHODS: We reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates. RESULTS: The most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem. CONCLUSION: Both TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.
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Humans , Angioplasty, Balloon , Aortic Diseases , Endovascular Procedures , Medical Records , StentsABSTRACT
Objective To study the feasibility and necessity of radial artery angiolgraphy in advance on transradial coronary intervention.Methods A total of 682 patients undergoing transradial coronary intervention were divided into two groups by random digits table method.Previous radial artery angiography (pre-RAA) group of 341 cases underwent radial artery angiography;post radial artery angiography (post-RAA) group of 341 cases in the guide wire,catheter in resistance immediately for radial artery angiography.The radial artery imaging characteristics were observed and the radial artery related complications were recorded in two groups.Results The ratio of radial artery spasm in post-RAA group was higher than that in pre-RAA group [11.4％(39/341) vs.6.2％(21/341),P=0.015].The ratio of operation failed in post-RAA group was higher than that in pre-RAA group [3.2％ (11/341) vs.0.6％ (2/341),P =0.014].The radial artery perforation rate and postoperative 1-6 months of radial artery occlusion rate increased significantly in post-RAA group,and there was significant difference between two groups (P ＜ 0.05).Conclusion Transradial coronary intervention in advance for radial artery angiography therapy can effectively observe the radial artery morphology,reduce the radial artery related complications.
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Objective: To access the application of percutaneous coronary angioplasty via radial artery in treatment of acute myocardial infarction. Methods: Totally 107 patients with acute myocardial infarction (AMI) were included in this study. Transradial approach (group A) percutaneous coronary intervention (PCI) was used in 56 patients and the transfemoral approach (group B) PCI was used in 51 patients. The successful rates of puncture procedure and PCI, time of artery carmulation, the carmulation to balloon inflation times, the total procedure time, and local puncture complications were compared between the 2 groups. Results: The successful rates of puncture procedure were IN% in both groups and their successful rates of PCI were higher than 96%. The time of artery carmulation, the cannulation to balloon inflation time, and the total procedure time were similar in group A and group B ([2.93±0.42] min vs [3.07±0.54] min, P=0.14; [17.23±3.47] min vs [16.81±4.86] min, P=0.61; [47.04±7.53] min vs [48.74±6.22] min, P=0.21, respectively). The incidence of bleeding and edema around puncture sites in group B was higher than that in group A (5/51 vs 0/56, P=0.016 4); the vagal reaction rate in group B was higher than that in group B (4/51 vs 0/56, P=0.032 7). Conclusion: Transradial access is a safe and feasible technique for performing percutaneous coronary intervention in treatment of acute myocardial infarction; it can decrease major bleeding complications.
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O acesso transradial é seguro e eficaz na realização de procedimentos coronários. Porém, seu uso pode estar comprometido em casos de variações anatômicas da artéria radial, espasmo e negatividade do teste de Allen. O acesso transulnar surge como uma alternativa viável em substituição à abordagem transradial. Reportamos o caso de um paciente submetido à angioplastia primária pela via ulnar com sucesso, sem complicações isquêmicas da mão, a despeito de oclusão prévia da artéria radial correspondente.
The transradial approach is safe and effective for coronary procedures. However, its use may be compromised in cases of variations in radial artery anatomy, spasms, and negative Allen's test. The transulnar approach emerges as a viable alternative to transradial approach. We report on a patient who underwent primary angioplasty via ulnar artery without ischemic hand complications despite prior occlusion of the ipsilateral radial artery.
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Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary/methods , Myocardial Infarction/therapy , Ulnar Artery , Hand/blood supply , Radial Artery , Ulnar ArteryABSTRACT
Surgical endarterectomy has been shown to be superior to medical treatment in the management of severe carotid stenosis. Endarterectomy, although effective, does have limitations, and percutaneous transluminal angioplasty with stent may offer an alternative modality of treatment. We report on a patient with severe coronary disease that femoral arterial cannulation was not possible due to aorto-femoral shunt operation and absent pulse. The transradial approach was used for aortography, bilateral carotid angiography and successful elective stent deployment in the left internal carotid artery. The transradial approach might be useful alternative in case of problems with femoral approach.
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Humans , Angiography , Angioplasty , Aortography , Carotid Arteries , Carotid Artery, Internal , Carotid Stenosis , Catheterization , Coronary Disease , Endarterectomy , StentsABSTRACT
BACKGROUND AND OBJECTIVES: Aggressive antithrombotic therapy and transfemoral primary intervention during acute myocardial infarction (AMI) restricts the patient's movement and may increase the risk of access site bleeding complications, and lengthen the duration of movement restriction and hospital stay. Transradial approach provides less bleeding complications and early ambulation. The purpose of this study is to know whether transradial primary intervention is safe and feasible in the patients with AMI. MATERIALS AND METHOD: From April 1998 to December 1998, transradial primary interventions were performed in the consecutive 28 patients (24 male, 57+/-7 years) by two experienced operators. The results were compared to the results of 44 (15 patients during same period, 29 during previous year) transfemoral primary interventions. RESULTS: 1)The success rates of transradial primary interventions was 93% (26/28) and comparable to 95% (42/44) of transfemoral primary interventions. 2)In transradial group, the time from the arrival of catheterization laboratory to arterial access and to reperfusion, the time from the arrival of emergency room to reperfusion were 8.1+/-3.4 minutes, 22.0+/-5.3 minutes, and 71.7+/-9.2 minutes, respectively and comparable to 9.0+/-3.1 minutes, 21.7+/-5.3 minutes, and 68.9+/-8.1 minutes of transfemoral group, respectively. 3)The complications of the procedure were treated successfully during transradial interventions. 4)In transradial group, puncture site bleeding complications were absent though heparin was continued and mild ambulation was possible early after the procedure. The hospital stay of transradial group was 5.3+/-1.3 days and shorter than 7.7+/-4.2 days of transfemoral group. CONCLUSION: In the low risk patients with AMI, transradial primary intervention might be safe and feasible with acceptable time delay by the experienced operators. It might be effective to reduce access site bleeding complications and to initiate early ambulation, resulting in the shortened hospital stay.
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Humans , Male , Catheterization , Catheters , Early Ambulation , Emergency Service, Hospital , Hemorrhage , Heparin , Length of Stay , Myocardial Infarction , Punctures , Reperfusion , WalkingABSTRACT
Anomalous right coronary artery arising from the left sinus of Valsalva is rare, but not protected from ather-osclerotic disease. Major factor determining successful angioplasty is the selection of the appropriate guiding catheter to provide optimal coaxial backup support. We report the first case of successful transradial stenting of an anomalous right coronary artery originating from the left sinus of Valsalva.
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Angioplasty , Catheters , Coronary Vessels , Sinus of Valsalva , StentsABSTRACT
0.05).Follow-up coronary angiography was more frequently performed in group A than in group B.Conclusion In patients with acute myocardial infarction treated with primary percutaneous coronary intervention,the transradial approach is a safe and feasible technique.With the higher rate of follow-up angiography,it was found that the incidence of MACE at 1-month follow-up and 6-month follow-up using the transradial approach was similar to transfemoral approach.Therefore,the transradial approach is expected to become the substitute approach for treatment in AMI patients.