Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

A diagnostic cerebral angiography is a vital tool in the planning and management of various cerebrovascular conditions. Newer angiographic modalities, such as digital subtraction angiography offers dynamic imaging of the cerebral blood flow and is the preferred diagnostic modality of choice when a subsequent intervention is contemplated. Traditionally, the transfemoral route at the groin was used as the site for vascular access. However, landmark randomised controlled trials in the field of interventional cardiology have demonstrated the safety, efficacy and patient comfort attained by employing a trans-radial access for angiography and interventions. This has spawned numerous studies which were directed explicitly towards cerebral angiography and neuro-intervention. We present this review of literature to consolidate the current practices and to encourage the neuro-interventionalists to shift to a radial first approach.

The application of trans-radial thrombus aspiration device in primary coronary interventional therapy / 中国介入心脏病学杂志

Objective To evaluate the effectiveness, safety and feasibility of the application of trans-radial thrombus aspiration in patient with heavy burden of thrombus receiving primary coronary interventional therapy. Methods 56 patients with acute coronary syndrome receiving primary coronary interventional therapy were enrolled and randomized to two groups. 31 patients received therapy of thrombus aspiration by Thrombuster II, while 25 patients received routine coronary interventional therapy. We compared the rate of major adverse cardiac event (MACE) in hospital, left ventricular ejection fraction (LVEF) one week post procedure and left ventricular end diastolic diameter (LVEDD), TIMI frame before and after procedure between two groups. Results The rate of MACE was signiifcantly (P<0.05) lower in patients receiving thrombus aspiration (3.3%) compared with routine PCI group (12.0%). LVEF and the rate of patients with TIMI Ⅲafter procedure were signiifcantly (P < 0.05) higher in patients receiving thrombus aspiration. There’s no significant difference in LVEDD between two groups. Conclusions There lies good safety and feasibility for applying thrombus aspiration combining direct PCI in patient with heavy burden of thrombus.

Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry

Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).

Cox regression of impact factors on local complications after trans-radial coronary intervention / 中国实用护理杂志

Objective To observe the rates of local complications (bleeding/swelling) after trans-radial coronary intervention (TRI),to investigate possible impact factors,in order to provide guidance for the prevention of these adverse events.Methods A total of 198 cases who performed TRI at the department of interventional cardiology of the First Affiliated Hospital of Sun Yat-sen University from August to December,2011 were included in the present study.Data with regards to local complications were collected peri-operatively,by means of direct inquiry,point-of-care observation and measurements,and laboratory testing.Patients who developed complications and patients who did not were compared in terms of compressor position,loosening protocol and so on.Variables with statistical significance in univariate analysis were further included in Cox regression.SPSS 18.0 software was applied for all statistical analysis.Results The relative risks (RR) of the following two variables,namely whether or not the midpoint of compressor was on the midline of forearm,and the vertical distance from the horizontal plate of the compressor to the puncture site,were 2.602 and 1.403,respectively.Conclusions The midpoint of compressor on the midline of forearm,and the vertical distance from the horizontal plate of the compressor to the puncture site were major risk factors of local complications after TRI.

Influencing factors of puncture site bleeding after trans-radial coronary intervention / 现代临床护理

Objective To investigate influencing factors of puncture site bleeding after trans-radial coronary intervention (TRI)in order to provide guidance for prevention of post-operative bleeding complications.Methods A total of 198 patients with TRI hospitalized at the department of interventional cardiology of our hospital from August,2011 to December,2011 were recruited in the study.In the prospective study,they were divided into two groups:bleeding group(n=62)and non-bleeding group(n=136).The general status,medication,position of radial compressor,time of immobilization of the wrist joint,duration of loosing tourniquet between the first time and second time and number of laps,time for depression,duration for total release of compression device and laboratory testing were recorded as data.Cox regression analysis was done to explore factors influencing bleeding.Results The factors for puncture site bleeding after trans-radial coronary intervention included pre-operative medications,location of compression device at the midline of operated forearm,distance between the compression device midpoint and the second wrist crease,and time for total release of compression device,with their RR=2.001,3.521,1.470 and 0.999,respectively.Conclusion Factors contributing to increased risk of local bleeding at puncture site following TRI included pre-operative medications,location of compression device at the midline of operated forearm,distance between the compression device midpoint and the second wrist crease;whereas the time for total release of compression device may be a protective factor.

Slender Percutaneous Coronary Intervention (“Slender PCI”) via Transradial approach by using 5Fr Guide Catheter- An Updated Single Center Experiences.

Background: Aim of the study was to evaluate the primary procedural success of slender PCI via transradial approach using either Bare-metal stents (BMS) or Drug Eluting Stent (DES). Methods: Total 10 patients were enrolled in this very preliminary study. Among them, Male: 8 and Female: 2. Clinical presentation were Ant MI: 4 (40%), Inf. MI: 2 (20%), Angina II-III: 3 (30%), and NSTEMI: 1 (10%). Total 10 stents were deployed. Mean age were for Male: 44yrs, for Female: 55yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Among the study group; 9 (90%) were Dyslipidemic, 5 (50%) were hypertensive; 6 (60%) patients were Diabetic, FH 6 (6%) and 8(63%) were all male smoker. Female patients were more obese (BMI M 24: F 27) and developed CAD in advance age. Common stented territory were LAD: 5 (50%) followed by RCA: 3 (30%) and LCX: 2 (20%). Average length and diameter of stent for LAD, RCA and LCX were 3.25, 3.16, 2.5 and 21.4, 20.3, 20 respectively. Stent used: BMS 3 (30%), Everolimus 5 (50%), Sirolimus 1(10%) and Zotarolimus 1(0.75%). Less contrast used (49.5ml), reduced radiation exposure (4727Gym2) and less fluoroscopy time (193 sec) with overall no procedural complication were observed. Conclusion: Our study has shown that the slender PCI via radial artery with a 5F guide catheter is safe with no procedural complication. It is also associated with less radiation exposure, less fluoroscopy time, good backup support and quick mobilization of patient.

Tran-Radial Percutaneous Coronary Intervention (PCI) is Safe and Alternative to Conventional Trans-Femoral Approach: Our Experiences at Apollo Hospitals Dhaka.

Background: Aim of the study was to assess the safety of the trans-radial Percutaneous coronary intervention (PCI) than conventional Trans-femoral approach by using either Bare-metal stents (BMS) and or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent. Also to see its safety in regards of procedural time, quick mobilization, less complication and less radiation exposure. Methods: Total 117 patients were randomized from a total of 538 patients who had PCI at our center in the quantifying period. Total 130 stent deployed in 117 patients. Among the patients, Male: 100 and Female:17 . Mean age were for Male: 55yrs, for Female:57yrs . Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Our study shows 21.7% had trans-radial PCI. Among the study group; 72 (61.5%) were Dyslipidemic, 75 (64.1%) were hypertensive: 47(40.2%) patients were Diabetic, FH 29 (24.8%) and 33(33%) were all male smoker. Female patients were more obese (BMI M 27: F 29) and developed CAD in advance age. Common stented territory were LAD 51 (43.6%) followed by RCA 41 (35%) and LCX 27(23%). Average length and diameter of stented vessel were almost same in all territory. Territory wise multiple or overlapping stenting was done in LAD 3 (6 stents), RCA 1(2stents), LCX 4 (10 stents). Stent used: BMS 37 (28.5%), Sirolimus 41(31.5%), Paclitaxel 27 (21%), Everolimus 22 (16.9%), Biolimus 2 (1.5%) and Zotarolimus 1(0.75%). Less Procedural time, reduced radiation exposure, no procedural complication and overall better patient comfort were observed. Conclusion: Our study has revealed that trans-radial PCI is safe with reduced radiation exposure, quick mobilization of patient and no procedural complication in all the case, indicates it can be done routinely as an alternative to conventional Trans-femoral approach.