Percutaneous radial artery approach for coronary angiography

Percutaneous entry into the distal radial artery and selective coronarography using a French 5 sheath and preshaded catheters were attempted in 100 patients with a normal Allen test. Cannulation of the radial artery was not possible in ten patients, and selective catheterization of the coronary arteries was unsuccessful in two. Manipulation of catheters presented no problem, and arterial spasm was rarely observed, only before the use of a 23-cm-long sheath. Only two complications without symptoms were observed: arterial dissection of the brachial artery in one patient and occlusion of the radial artery in another. With experience, this approach may become as effective and possibly safer than the transbrachial entry.     

Different reactivity of the proximal and distal segments of the radial artery to vasoconstrictors in patients undergoing coronary artery bypass grafting

BACKGROUND: Complete arterial revascularisation using the radial artery (RA) is an attractive alternative to venous graft implantation for the coronary artery bypass grafting (CABG). In spite of the favourable long-term results of this approach, the sensitivity of RA to vasoconstriction and spasm is still limiting its use. It has been suggested that vasospastic properties of the artery may differ depending on the location (proximal or distal). AIM: To compare the vasoreactive properties of proximal and distal sections of RA grafts. METHODS: Proximal and distal segments of RA were obtained from 27 patients undergoing CABG and isometric recordings of changes in smooth muscle force were performed mounted in the organ bath. Responses to cumulatively increasing concentrations of phenylephrine (PE), angiotensin II (AT-II), prostaglandin F2 (PGF2) and endothelin-3 (ET-3) were evaluated. RESULTS: Both proximal and distal segments of RA constricted in response to KCl, PE, AT-II, PGF2 and ET-3. Proximal segments demonstrate significantly greater spastic response to KCl, as well as to receptor-mediated agonists PE and more importantly vasoactive peptide AT-II. These differences remained statistically significant after correcting for vessel size and weight. In contrast, reactivity of both segments of RA to increasing cumulative doses of PGF2 and ET-3 was similar. CONCLUSION: Proximal segments of the radial artery are more susceptible to vasoconstriction induced by PE and AT-II, which should be taken into consideration in the clinical setting of CABG surgery. Increased muscle content in this segment does not fully explain this difference, which may result from varying receptor density and properties.     

Impact of radial artery cannulation for coronary angiography and angioplasty on radial artery function

The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting.     

经桡动脉行冠状动脉造影术的安全性观察

目的探讨经桡动脉行冠状动脉(冠脉)造影术的特点及安全性。方法200例患者接受经桡动脉径路行冠脉造影术。结果196例成功,4例失败,其中3例桡动脉迂曲畸形导丝不能通过,1例为锁骨下动脉闭塞。所有患者无严重的并发症出现。结论桡动脉径路行冠状动脉造影具有止血容易,患者卧床时间短和并发症少的优点,是一种安全、有效的介入途径。     

经远端桡动脉路径行冠状动脉介入诊疗的Meta分析

目的 通过Meta分析评价经远端桡动脉路径行冠状动脉介入诊疗的安全性与有效性.方法 计算机检索 Pubmed、Embase、Web of Science、Cochrane Library、中国生物医学服务系统(Sinomed)、中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普(VIP)等数据...     

Vasospasms of the radial artery after the transradial approach for coronary angiography and angioplasty

We examined vasospasms of the radial artery after a transradial approach was used for coronary angiography or angioplasty. In forty-eight patients (39 males and 9 females), arteriography of the radial artery was initially performed just after the transradial approach was used for coronary angiography and/or angioplasty. Then, five months later, a second arteriography of the radial artery was obtained after a transbrachial approach was used for coronary angiography. First and second arteriographies were compared to evaluate vaso-spasms of the radial artery. In the present study, more than 75% stenosis in the radial artery, 25-75% stenosis, and less than 25% stenosis were tentatively defined as severe spasms, moderate spasms, and mild spasms, respectively. In arteriographic studies on the radial artery, twenty-four patients (50%) had severe radial artery spasms, eleven patients (23%) had moderate spasms, and thirteen patients (27%) had mild spasms. The diameters of both the proximal and distal radial arteries in the severe spasm group were significantly smaller than those in the mild and moderate spasm groups (proximal site: severe group 2.39 +/- 0.70 mm versus mild group 2.98 +/- 0.46 mm, P < 0.05, and moderate group 2.96 +/- 0.77 mm, P < 0.05, distal site: severe group 2.26 +/- 0.60 mm versus mild group 2.73 +/- 0.47 mm, P < 0.05, and moderate group 2.86 +/- 0.71 mm, P < 0.05). We concluded that vasospasms of the radial artery occurred in most patients after the transradial approach. Furthermore, severe radial spasms were strongly correlated with the size of the diameter of the artery.     

冠状动脉造影术前应用高频超声评价桡尺动脉的价值

目的:探讨高频超声在冠状动脉造影术前评价桡尺动脉的价值。方法:2008年12月至2009年6月我院心内科住院患者150例在冠状动脉造影术前行双侧桡、尺动脉的彩色多普勒超声检查,检查范围包括双侧桡动脉、尺动脉、肱动脉及腋动脉。结果:150例受检者上肢动脉变异及不同程度的走行迂曲12例,管径纤细2例。走行异常及迂曲的12例中有11例成功进行了经右桡动脉冠状动脉造影术,1例行经左桡动脉冠状动脉造影术,另外管径纤细2例进行了经股动脉冠状动脉造影术。结论:冠状动脉造影术前应用高频超声检测桡尺动脉,可以为临床选择穿刺途径提供依据,提高穿刺、插管及导丝行进的成功率。     

Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery

Radial artery access has transformed cardiac catheterisation, allowing it to be performed in a daycase setting, saving both hospital beds, and nursing care costs. However, there are two common and seemingly diametrically opposite complications. These are radial artery occlusion and forearm haematoma; the former could be reduced by heparin, but at the expense of precipitating the latter. These complications increase proportionally to the size of radial artery sheath used. Interestingly, by cannulating the radial artery more distally beyond its bifurcation in the hand, the distal radial approach appears to be the ‘one stone, two birds’ or the synchronous Chinese idiom, ‘yīshí’èrniăo’s’ solution, reducing both complications at the same time. Extending this further and downsizing to a 4Fr catheter system, heparin use could be spared altogether, without complications, and haemostasis achieved with short manual pressure at the puncture site. Hence, further cost savings by foregoing commercial compression bands, and abolishing access site care for nurses. We illustrate the above strategy in a patient with challenging radial anatomy, made simple and easy.Key words: coronary angiography, distal radial artery, haemostasis, heparin, radial artery occlusion     

Extraction of the radial artery during transradial coronary angiography: an unusual complication

The transradial approach is currently an accepted alternative for vascular access during percutaneous coronary interventions. Access-site complications, such as mild hematoma, hematic effusions, and reduced or absent radial pulse, have been reported. We report the occurrence of total extraction of the radial artery during sheath removal. The occurrence of this complication emphasizes the need for meticulous attention and prudence when a patient complains of local pain during sheath extraction.     

经解剖鼻烟壶处的远端桡动脉入路行冠状动脉造影及支架术1例

1989年Campeau[1]首次报道以桡动脉为入路进行冠状动脉造影,1993荷兰Keimeneij等[2]首次报道经桡动脉行冠状动脉支架术,随后更多的临床研究发表,使经桡动脉途径介入诊疗(TRI)已成为一种成熟的介入诊疗途径[2-3]。经桡动脉进行冠状动脉介入治疗的优势是减少出血,增加安全性和增加患者舒适度[4-5]。而经股动脉入路的血管相关并发症和出血增加患者并发症发生率、病死率和住院时间,特别是给予了抗凝和抗血小板治疗后[6-7]。     

Single coronary artery: right coronary artery originating from distal left circumflex

This report describes a patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. However, this anomaly was not of clinical significance based on atypical nature of chest pain, negative thallium exercise test and absence of coronary obstruction.     

Size of distal radial and distal ulnar arteries in adults of southern Rajasthan and their implications for percutaneous coronary interventions

Aims and objectives

Transradial interventions are gaining popularity in recent years. However the radial artery being small, there is a limitation in using interventional devices through this route. We have measured radial and ulnar arteries size in adult patients at our tertiary care cardiology center in southern Rajasthan.

Method

Adult patients >30 years, who came for Echocardiography at a tertiary care center were included. Radial and ulnar arteries inner diameters were measured 2–3 cm above the Styloid process in both forearms with the Ultrasonography. Patient information about weight, height, diabetes and hypertension were collected. Body mass index and Body surface area were calculated.

Results

We studied 204 patients, which includes 60.8% males. Mean diameter was 2.325 ± 0.4 mm mm for radial arteries and 2.358 ± 0.39 mm for ulnar arteries (p = 0.24). Hypertensive and male patients had larger mean radial artery diameter than non hypertensive (2.383 mm v/s 2.272 mm, p = 0.006) and female patients (2.37 mm v/s 2.26 mm, p = 0.008) respectively. Diabetic patients (2.305 mm) had nonsignificantly smaller radial arteries diameters than nondiabetics (2.329 mm, p = 0.6). We calculated correlations between radial arteries diameters and Body surface area, Body mass index, height and weight of patients, none of these correlations were statistically significant (r = 0.30, r = 0.28, r = 0.07, r = 0.031 respectively).

Conclusion

Mean radial artery diameter (2.325 ± 0.4 mm) in the study was slightly smaller than ulnar artery (2.358 ± 0.39 mm). Males and hypertensives had a larger mean radial artery diameter than females and non hypertensives. Radial artery inner diameter measurement by Ultrasonography may be more helpful than Allen''s test for ideal selection of cases.     

Stenting of a stenotic radial artery coronary graft: a new therapeutic scenario in coronary artery disease

With the increasing application of arterial coronary revascularization, a number of patients may develop arterial graft obstructive disease. In addition, the predominantly muscular structure of the radial artery wall may predispose radial artery coronary grafts to spasm. For the first time, we describe a case of stenting of a stenotic free radial artery graft and discuss the technical and pathophysiological aspects of the procedure.     

Status of the grafts and the native coronary arteries proximal and distal to coronary anastomotic sites of aortocoronary bypass grafts.

The status of the native coronary arteries at necropsy in the vicinity of the coronary anastomoses of saphenous vein aortocoronary bypass grafts in 20 patients with severe coronary heart disease is presented. Of the 37 graft systems (graft plus coronary artery into which graft inserted) analyzed, the lumina of 44% of the native coronary arteries within the first 2 cm distal to the anastomoses were greater than 75% narrowed in cross-sectional area by atherosclerotic plaques, and the native coronary artery at the site of the anastomosis was greater than 50% narrowed in cross-sectional area already by atheroclerotic plaque in 25% of the graft systems. The mean coronary arterial size distal to the site of the coronary graft anastomosis, even after correction for heart weight, was greater in the 13 men than in the seven women. The residual luminal areas squared per gram of heart weight, however, were similar in both men and women. These results suggest that 1) relative coronary vessel size is greater in men than women; 2) the luminal area squared per gram myocardial mass (a relative estimation of flow) is the same in the two groups of patients; and 3) less atherosclerotic plaque is necessary in women then in men to produce similar limitation to coronary flow. Thus, vessel size alone cannot account for the higher reported frequency of unsuccessful aortocoronary bypass procedures in women.     

Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization

BackgroundThe distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery.MethodsTotal of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization.ResultsThe mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p < 0.001). Females had significantly smaller radial artery diameter as compared to males at right conventional access site (2.42 ± 0.36 mm vs 2.60 ± 0.34 mm; p < 0.001) and distal access site (2.09 ± 0.38 mm vs 2.27 ± 0.39 mm; p < 0.001). The diameter of the right dRA was not significantly correlated with age (r² linear = 0.002, p = 0.0475) but was positively correlated with height and weight (r² linear = 0.076, p = <0.001 and r² linear = 0.005, p = <0.001) and negatively correlated with BMI (r² linear = 0.076, p = 0.519).ConclusionsThis study has shown the size of right dRA 2.27 + 0.39 mm in males and 2.09 + 0.38 mm in females. Diabetes, hypertension, height and weight are important predictors of dRA diameter.     

Right versus left radial artery approach for coronary angiography. Differences observed and the learning curve

There are anatomical differences between right and left radial artery approaches for coronary catheterization that could influence application of the technique. We present the results of a randomized study that compared the effectiveness of the two approaches and identified factors associated with failure of the procedure. The study involved 351 consecutive patients: a left radial approach was used in 180, and a right radial approach, in 171. The procedure could not be completed using the initial approach selected in 15 patients (11 right radial vs. 4 left radial; P=.007). Use of a right radial approach, lack of catheterization experience, patient age >70 years, and the absence of hypertension were found to be independently associated with prolonged fluoroscopy duration and failure using the initial approach. Use of the right radial approach in patients aged over 70 years was associated with a 6-fold increase in the risk of an adverse event. Consequently, use of the right radial approach should be avoided in patients aged over 70 years when trainee practitioners are on the learning curve.