ABSTRACT
OBJECTIVES: The aim of this study was to compare manual versus mechanical compression of the radial artery after coronary angiography via transradial access regarding radial artery occlusion (RAO), access-site bleeding complications, and duration of hemostasis. BACKGROUND: Hemostasis of the radial artery after sheath removal can be achieved either by manual compression at the puncture site or by using a mechanical hemostasis device. Because mechanical compression exerts a more stable, continuous pressure on the artery, it could be hypothesized that it is more effective compared with manual compression regarding hemostasis time, bleeding, and RAO risks. METHODS: A total of 589 patients undergoing diagnostic coronary angiography by transradial access with a 5-F sheath were randomized in a 1:1 ratio to receive either manual or mechanical patent hemostasis of the radial artery. Radial artery patency was evaluated by color duplex ultrasonography 24 h after the procedure. The primary endpoint was early RAO at 24 h. Secondary endpoints included access-site bleeding complications and duration of hemostasis. RESULTS: Thirty-six (12%) early RAOs occurred in the manual group, and 24 (8%) occurred in the mechanical group (p = 0.176). There were no significant differences between the 2 groups regarding access-site bleeding complications (hematoma, 52 [17%] vs. 50 [18%]; p = 0.749; bleedings, 8 [3%] vs. 9 [3%]; p = 1.000). Duration of hemostasis was significantly shorter in the manual group (22 ± 34 min vs. 119 ± 72 min with mechanical compression; p < 0.001). CONCLUSIONS: Manual and mechanical compression resulted in similar rates of early RAO, although the total duration of hemostasis was significantly shorter in the manual group.
Subject(s)
Catheterization, Peripheral/adverse effects , Coronary Angiography , Hemorrhage/prevention & control , Hemostatic Techniques , Radial Artery , Aged , Female , Greece , Hemorrhage/etiology , Hemostatic Techniques/adverse effects , Humans , Male , Middle Aged , Pressure , Prospective Studies , Punctures , Radial Artery/diagnostic imaging , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
We present a case of successful percutaneous revascularization of a chronic total coronary occlusion due to in-stent restenosis. The CrossBoss catheter (BridgePoint Medical, Minneapolis, MN, USA) was used initially because it is reported to be effective in this setting with a low risk of exiting occluded stents. To the best of our knowledge, this is the first reported case of a CrossBoss penetrating through stent struts into the subintimal space. The case was completed via the retrograde approach with 'rendezvous in coronary'.
ABSTRACT
Percutaneous revascularisation in anomalous coronary arteries poses certain technical difficulties, especially in the selective cannulation of the diseased vessel and the coaxial positioning of the guiding catheter for optimum stability. We report a case of successful stent implantation in a single coronary artery (SCA) arising from the right sinus of Valsalva (SoV). The ART 4 (Boston Scientific) guiding catheter provided excellent back-up support for stent delivery in the diseased circumflex artery. We also discuss the anatomical variations of an SCA originating from the right SoV, their angiographic recognition, the clinical implications, as well as technical considerations that should be taken into account when performing percutaneous interventions in these vessels.
