Ad hoc transradial coronary angioplasty strategy: experience and results in a single centre.

BACKGROUND: The combination of diagnostic and angioplasty as a single procedure is becoming common practice in many institutions, but the feasibility of this strategy performed with the transradial approach in a large group of patients has not been evaluated. This study was performed to explore the feasibility, safety and cost-effectiveness of the transradial approach as a single procedure for diagnostic angiography and angioplasty, including stent implantation. METHODS: From February 1999 and November 2000 the percutaneous transradial approach was attempted in 800 patients with functional radial arch attested using Allen's test. Interventional procedures, PTCA and stent implantation, when indicated and appropriated, have been performed as a single procedure. RESULTS: Out of 800 patients submitted to coronarography, 390 were treated with PTCA and or stent implantation as single procedure. In this group of patients, 425 lesions (1.2 lesions/patient) were treated. A PTCA was performed in 98 (23.5%) lesions and PTCA plus stent implantation were performed in 327 (76.5%) lesions. Procedural success was achieved in 419/425 lesions (98.5%) in the radial group and in 98% in the staged group. The mean time to place the sheath was longer in the transradial group (P<0.01), but the time required to obtain hemostasis was markedly shorter in the transradial patients (P<0.01); no differences in fluoroscopy time, contrast volume and catheters per case was found. Access site bleeding complications were significantly reduced in the radial group (P<0.01) and total hospital length of stay was lesser in the radial group (mean days 1.9) as compared to femoral group (mean days 2.9) with a reduction of total hospital charge. The reduction of costs for 100 patients was Euro 78,000. CONCLUSION: Our results show that a combined strategy of angiography and angioplasty via the radial artery is feasible, safe, more comfortable for the patient, and more cost-effective than a staged procedure. This approach might be ideal for outpatient or ad hoc invasive coronary procedures.

Transradial approach for renal percutaneous transluminal angioplasty and stenting: a feasibility pilot study.

BACKGROUND: Stent implantation of renal stenosis (RS) has been reported on extensively; this technique is perceived as superior to balloon angioplasty alone and less invasive than surgical revascularization. With the development of new accessories and stents, we can now improve and optimize procedural and clinical results. In this pilot study, we tested an alternative minimally invasive approach for renal stenting: the transradial artery catheterization (TAC) and a 6 French (Fr) system for stenting. METHODS: In this feasibility study, we enrolled patients with RS uncontrolled hypertension and/or chronic renal insufficiency. After assuring good dual blood supply (Allen test), TAC was attempted. The guiding catheters chosen for stenting were 6 Fr (0.70 ) Zuma 2 (Medtronic AVE, Santa Rosa, California). The selection of the guiding catheter was performed with respect to back-up support and coaxial alignment. RS were crossed with a coronary extra support guidewire (0.0.14 mailman, Boston Scientific/Scimed, Maple Grove, Minnesota). A balloon angioplasty before stenting was performed only in presence of subocclusive calcified stenosis, otherwise direct stenting was performed. We used low profile stents (12 16 mm LP Sulzer stent, IntraTherapeutics Inc., Minnesota) manually crimped on monorail balloon (5.0 6.0 mm x 20 mm). Immediately after completion of the procedure, the sheath was removed and a selective radial artery compression device was used for hemostasis. Patients were not restricted to bedrest, but were discharged the following day. RESULTS: There were 25 patients in the study population. Procedural indications were poorly controlled hypertension in 15/25 patients and/or preservation of renal function in 10/25 patients. Procedural success was obtained in 27/27 lesions (100%). Direct stenting was performed in 24/27 stenosis; predilatation was necessary in 3/27. We used 1 stent per lesion. The mean fluoro time was 7 5 minutes/lesion and mean procedural time was 14 5 minutes/lesion. No procedural and clinical complications occurred during the procedures upon the discharge. CONCLUSIONS: Our results confirmed the safety of this approach in the treatment of RS. The devices used in the study were those traditionally used for coronary procedures. The adoption of these materials and techniques have simplified the procedure and has permitted a reduction of fluoro and procedural time. An additional advantage has been the passive achievement of hemostasis by pressure devices reducing the workload of nursing and medical staff with elimination of bleeding complications that allowed immediate post procedural ambulation.