International Hand Function Study Following Distal Radial Access: The RATATOUILLE Study

BackgroundDistal radial access (DRA) has been proposed to improve procedure ergonomics and favor radial artery patency. Although promising data, nothing is known on evolving hand function after DRA.ObjectivesThis study sought to comprehensively evaluate hand function in patients undergoing DRA.MethodsReal-world patients undergoing DRA undertook a thorough multimodality assessment of hand function implementing multidomain questionnaires (Disabilities of the Arm, Shoulder and Hand and Levine-Katz), and motor (pinch grip test) and sensory (Semmes-Weinstein monofilaments test) examinations of both hands. All assessments were performed at preprocedural baseline and planned at 1-, 6-, and 12-month follow-up (FU). Adverse clinical and procedural events were documented too.ResultsData of 313 patients (220 men, age 66 ± 10 years) from 9 international centers were analyzed. The Disabilities of the Arm, Shoulder and Hand and the Levine-Katz scores slightly improved from baseline to FU (P = 0.008 and P = 0.029, respectively). Pinch strength mildly improved from baseline to FU (P < 0.001 for both the left and right hands). Similarly, touch pressure threshold appeared to faintly improve in both the left and right hands (P < 0.012 for all the sites). For both motor and sensory function tests, comparable findings were found for the DRA hand and the contralateral one, with no significant differences between them. Repeated assessment of all tests over all FU time points similarly showed lack of worsening hand function. Access-related adverse events included 19 harmless bleedings and 3 forearm radial artery and 3 distal radial artery occlusions. None affected hand function at FU.ConclusionsIn a systematic multidimensional assessment, DRA was not associated with hand function impairment. Moreover, DRA emerges as a safe alternative vascular access.     

Technique for ipsilateral rescue embolization of common femoral side branch vessel injury.

We report a novel double wire technique for ipsilateral access of the external iliac/common femoral artery transition side-branches in a patient with active extravasation. The case is noteworthy in that asymptomatic extravasation was noted in both the inferior epigastric and deep circumflex iliac branches on femoral angiography prior to intraaortic balloon pump insertion following emergent diagnostic left heart cathetrization. We speculate the side branch injury was related to the J-wire and describe how this complication may be best treated by the ipsilateral technique reported herein.     

Interatrial septum rupture during balloon measurement of a patent foramen ovale in a young patient presenting cryptogenic stroke.

We report the case of a 36-year-old woman admitted for cryptogenic stroke, in whom the Patent Foramen Ovale (PFO) diameter measurement, with a purpose built sizing balloon, performed before the closure procedure, was complicated with the rupture of the inter-atrial septum generating an Atrial Septal Defect (ASD) with a significant left-to-right shunt. This kind of complication may not be easy to handle, changing the initial procedural strategy from PFO to ASD closure technique requiring specific material and operator's technical skill.     

Two‐stage percutaneous closure of mitral periprosthetic valvular leak

Periprosthetic valve leak can develop as a complication of valve replacement surgery and may manifest as symptomatic valvular regurgitation, heart failure, or haemolysis. We report a case of severe mitral periprosthetic valve leak requiring a two‐stage percutaneous closure technique with multiple Amplatzer® III vascular plugs.© 2011 Wiley‐Liss, Inc.     

A novel use of a split sheath to maintain vessel access when guidewire exchange is not possible

After inserting a catheter into a vessel, guidewire exchange technique must be used to maintain vascular access. If the lumen of the catheter is blocked and the guidewire exchange cannot be used, the catheter can only be removed, vascular access is lost, and an alternate vascular approach attempted. We describe a technique to remove the blocked catheter and still maintain vascular access. © 2008 Wiley‐Liss, Inc.     

Feasibility and safety of transradial artery approach for selective cerebral angiography.

The transradial artery (TRA) approach is a conventional means of diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of cerebrovascular angiographic studies using the TRA approach for patients with brain ischemia has not been reported. This study investigated whether the TRA approach using 6 Fr Kimny guiding catheter for both extracranial and intracranial angiographies is safe and effective for patients with a history of stroke, transient ischemic attack, or significant carotid stenosis. From February 2003 to June 2004, a total of 46 consecutive patients with an age range from 50 to 83 years were enrolled into the study. The retrograde engagement technique that involved lopping the guiding catheter was utilized. Outpatient carotid angiography was performed in 40% of the study patients. The overall procedural success (defined as completely evaluating both carotid and vertebral arteries and intracranial vessels) was 93.5% (n = 43) using the Kimny guiding catheter. Significant cerebrovascular stenosis (> 50%), including carotid artery in 52.2% (n = 24), vertebral artery in 15.2% (n = 7), and intracranial major artery in 15.2% (n = 7), was found in 82.6% of the patients. Notably, 17 (37.0%) of these patients with severe carotid stenosis (> or = 70%) required staged carotid stenting. Concomitant vertebral artery stenting was performed in four (8.7%) patients because of severe stenosis (> or = 70%) of these vessels. Two patients experienced transient dizziness (duration < 30 min) following the procedure. TRA approach for selective cerebral angiography is safe and feasible in patients with a history of brain ischemia.     

Distal transradial access for post-CABG coronary and surgical grafts angiography and interventions

BackgroundPost-CABG coronary and grafts angiography (CGAG) and interventions (PCI) have historically been performed via classic transfemoral approach. Particularly for those with left internal mammary artery (LIMA) grafts, left standard transradial access (lsTRA) represents a feasible alternative, with significant fewer vascular complications, but it has ergonomic disadvantage for the operator because of the need to bend over the patients, especially in obese ones. Distal transradial access (dTRA) may provide important advantages, including shorter hemostasis and greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim to describe the feasibility and safety of right and left dTRA for post-CABG CGAG and PCI.Material and methodsFrom February 2019 to April 2021, 111 consecutive post-CABG patients submitted to CGAG and/or PCI via dTRA have been enrolled.ResultsMean patient age was 67.6 years old. Most were male (88.3%) and had chronic coronary syndromes (61.3%). Overall, 35.1% had acute coronary syndromes. Distal RA was successfully punctured in all 111 patients, always without ultrasound guidance. All procedures involving LIMA grafts were done via ipsilateral ldTRA. We had only 5 (4.5%) access site crossovers. Successful dTRA sheath insertion was then achieved in 95.5% of all patients, mostly (74.8%) via ldTRA and with standard 6Fr sheath (99.1%). Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications related to dTRA were recorded.ConclusionsdTRA for routine post-CABG CGAG and PCI by experienced transradial operators appears to be feasible. Further randomized and larger trials are needed to assure clinical benefits and safety of this new technique.