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Suggestion Title Author Date Recommended File
Radialists perform better femoral percutaneous coronary intervention (PCI) Nolan J - AIMRADIAL 2015 - Radialists and femoral access 10/17/2015 0 Slideshare Add to my favorites
Transradial approach for cardiac catheterization in patients with negative Allen’s test Koutouzis M - AIMRADIAL 2015 - Transradial and negative Allen test 10/17/2015 0 Slideshare Add to my favorites
‘Mother-in-child’ thrombectomy technique: a novel and effective approach to decrease intracoronary thrombus burden in acute myocardial infarction Dauvergne, C. Araya, M. Uriarte, P. Novoa, O. Novoa, L. Maluenda, G. 2013 0 Html Add to my favorites

BACKGROUND: The presence of large thrombus burden in patients presenting with acute myocardial infarction (AMI) is common and associated with poor prognosis. This study aimed to describe the feasibility and safety of the novel ‘mother-in-child’ thrombectomy (MCT) technique in patients presenting with AMI and large thrombus burden undergoing percutaneous coronary intervention (PCI). METHODS: We studied 13 patients presenting with AMI who underwent PCI with persistent large intracoronary thrombus after standard thrombectomy. The procedure was performed using a 5F ‘Heartrail II-ST01′ catheter (Terumo Medical) into a 6F guiding system. Angiographic assessment of thrombus burden and coronary flow was obtained at baseline, immediately after thrombectomy and at the end of the procedure. RESULTS: The mean age was 55.9+/-13.0 years and involved mostly males (76.9%). All patients underwent PCI via radial approach. Following MCT Thrombolysis In Myocardial Infarction (TIMI) flow improved by 2 or more degrees in 11 patients (84.5%), while visible angiographic thrombus was reduced in 11 patients (84.5%). In the final angiogram, normal TIMI flow was restored in 11 patients (84.5%), with normal myocardial ‘blush’ in 7 patients (53.8%) and total clearance of a visible thrombus in 7 patients (53.8%). Overall, 6 patients received thrombectomy as ‘stand-alone’ procedure. All patients were discharged alive after a mean of 5.6+/-2 days. CONCLUSION: This initial report suggests that significant reduction in thrombus burden and improvement of the coronary flow can be safely achieved in patients presenting with AMI and large thrombus burden by using the novel MCT technique.

5 French (5Fr) compatible thrombosuction in STEMI (ST-segment elevation myocardial infarction) Amoroso G - AIMRADIAL 2015 - Thrombectomy and radial approach 10/17/2015 0 Slideshare Add to my favorites
8 french transradial coronary interventions: clinical outcome and late effects on the radial artery and hand function Wu S.S., Galani, R. J., Bahro, A., Moore, J. A., Burket, M. W., Cooper, C. J. 2000 0 Html Add to my favorites

BACKGROUND: Limited information is available on the effects of 8 French (Fr) transradial procedures on radial patency. In addition, the effects of radial procedures and radial occlusion on hand function are unknown. METHODS: Two groups were recruited: twenty-four patients who had undergone 26 transradial 8 Fr interventions and 16 patients who had undergone 16 transradial 6 Fr procedures. At 1 year, radial patency, hand strength and hand endurance were measured. RESULTS: No major adverse cardiac events or vascular complications were noted in either group. Late radial occlusion was noted in 2/18 (11%) 8 Fr patients and 3/16 (19%) 6 Fr patients (p = ns). There were no differences in the 8 Fr group between the catheterized and uncatheterized radial arteries for diameter (3.2 +/- 1.1 mm versus 3.3 +/- 0.7 mm, respectively,p = NS) or volumetric flow (55 +/- 51 ml/minute versus 57 +/- 45 ml/minute, respectively,p = NS). No differences in hand strength or hand endurance were seen between the catheterized and uncatheterized arms in the 8 Fr group, between the 8 Fr and 6 Fr groups, or between occluded and non-occluded patients. CONCLUSION: Transradial use of 8 Fr guiding catheters appears to be feasible and safe in highly selected patients, albeit associated with a low incidence of silent radial occlusion. Additionally, neither the use of 8 Fr sheaths nor the presence of radial artery occlusion appear to adversely affect hand strength or endurance.

A “modified crossover technique” for vascular access management in high-risk patients undergoing transfemoral transcatheter aortic valve implantation Buchanan, G. L. Chieffo, A. Montorfano, M. Maccagni, D. Maisano, F. Latib, A. Covello, R. D. Grimaldi, A. Alfieri, O. Colombo, A. 2013 0 Html Add to my favorites

OBJECTIVES: To describe results from our “modified crossover technique” for vascular access management during transcatheter aortic valve implantation (TAVI). BACKGROUND: Vascular access management remains a major cause of complications following TAVI due to the large bore sheaths required. METHODS: All suitable patients undergoing TAVI in our center, between June and August 2011, underwent our “modified crossover technique,” which enables the passage of a balloon through left radial access and inflation in the proximal iliac to allow percutaneous closure in a clean field. RESULTS: In total, 15 patients were included: the logistic EuroSCORE was 19.7 +/- 12.1% and STS score 5.7 +/- 5.6%. The mean therapeutic femoral access site diameter was 8.1 +/- 1.0 mm. Ten (66.7%) patients received Edwards SAPIEN XT (two using the new E-sheath) and five (33.3%) patients a Medtronic CoreValve ReValving System(R) device. The “modified crossover technique” was used successfully in all patients. There were three vascular complications occurring at the therapeutic access site: one rupture of the external iliac artery, one Prostar failure, and one pseudoaneurysm of the right common femoral artery. All complications were successfully treated percutaneously with covered stent implantation via access from the contralateral femoral artery. In view of the balloon inflation from the left radial artery, the complications could be treated in a clean field with minimal blood loss. CONCLUSIONS: Our “modified crossover technique” using the left radial artery as the diagnostic site for balloon inflation appears a helpful adjunct in managing TAVI vascular access sites.

A 5Fr catheter approach reduces patient discomfort during transradial coronary intervention compared with a 6Fr approach: a prospective randomized study Gwon H.C., Doh, J. H., Choi, J. H., Lee, S. H., Hong, K. P., Park, J. E., Seo, J. D. 2006 0 Html Add to my favorites

Smaller guiding catheters can help reduce local complications and patient morbidity during transradial coronary intervention (TRI). This study was designed to compare the patient’s morbidity, success rate, and the operator’s convenience between 5-French (5Fr) and 6-French (6Fr) TRIs. This is a single-center prospective randomized study. Patients who underwent TRI, in 2003, were prospectively randomized to either 5Fr or 6Fr catheter groups (100 patients in each group). Procedure-related patient morbidity as well as clinical and procedural characteristics was scored and analyzed. Procedural success rate was not significantly different between the groups. The number of unsatisfactory supports (6% in 5Fr group, 3% in 6Fr group,P=0.31) and the incidence of local wound complications were not significantly different between the groups. Local wound pain scores were significantly lower in the 5Fr group compared with the 6Fr group, particularly during sheath insertion and removal, and during procedures. Pain scores were higher in female patients than in male patients during sheath removal (male: 1.3+/-1.3, female: 1.7+/-1.5,P=0.049). Radial artery diameter was well correlated with local pain score during sheath removal (r=0.31, P<0.001), and with the height and weight of the patients (height: r=0.33, P<0.001,weight: r=0.27, P<0.001). In conclusion, using a 5Fr catheter during TRI reduce, local access site pain, particularly in female patients with smaller body size, whereas the success and local complication rates were similar to a 6Fr approach.

A big challenge to radialists Saito, S. 2010 0 Html Add to my favorites
A case achieved successful revascularization to severe ischemic coronary artery disease after endovascular recanalization with infrarenal aortic occlusion Sakamoto, Y. Muramatsu, T. Tsukahara, R. Ito, Y. Ishimori, H. Hirano, K. Nakano, M. 2012 0 Html Add to my favorites

An 80-year-old woman was admitted to our emergency department with ongoing dyspnea for 2 weeks. The patient was immediately intubated endotracheally because of the hypoxia with flush pulmonary edema. Electrocardiogram showed ST depression and echocardiogram showed hypokinesis of anterior left ventricular wall with poor systolic function. Also her cardiac enzymes were elevated, emergency coronary angiogram was performed from radial artery because both femoral arteries were not fully palpable. Coronary angiogram showed three vessels disease including chronic total occlusion of right coronary artery and left main bifurcation lesion. Also blood flow of left anterior descending coronary artery was delayed. Acute coronary syndrome was the cause of acute heart failure and revascularization was needed but aortography revealed total occlusion of infrarenal aorta. Patient was relatively hemodynamically stable; we planned treating total occlusion of infrarenal aorta with endovascular therapy to maintain a rout for cardiopulmonary support system. With bi-directional approach from both femoral artery and left brachial artery, occlusion site with heavy calcification was finally passed through by guide wire from retrograde approach. After pull-through technique, self-expanding nitinol stent was implanted after pre dilation with small balloon. Considering her EURO score, supposed perioperative mortality was high, percutaneous coronary intervention was performed. A 7 fr sheath was inserted from right femoral artery and intra-aortic balloon pump was inserted from left femoral artery. Sirolimus-eluting stent was implanted to left circumflex artery and also from ostium of left main to mid left anterior descending coronary artery after using an atherectomy device. After successful revascularization, patient became hemodynamically stable and weaning off the respirator was successful. Reporting case achieved successful revascularization to severe coronary artery disease after endovascular recanalization with infrarenal aortic occlusion.

A case of acute brachial artery occlusion after transradial coronary intervention Sang Z, Jin H, Liu Z 2013 0 Html Add to my favorites

In 2010, a 49-year-old man was admitted to our hospital with chest pain. Angiography via the radial approach was performed. Acute brachial artery occlusion was present after the procedure. By transcatheter thrombolysis, brachial artery occlusion was recanalized. Transcatheter thrombolysis seemed to be effective and safe.

A case of complex regional pain syndrome type II after transradial coronary intervention Sasano N., Tsuda, T., Sasano, H., Ito, S., Sobue, K., Katsuya, H. 2004 0 Html Add to my favorites

The transradial approach for coronary catheterization is now a routine technique without serious complications at the puncture site. We report a case of complex regional pain syndrome type II (CRPS type II) in the hand after the transradial coronary intervention, which may alert medical personnel that the technique may cause serious regional pain with disability. A 61-year-old woman underwent coronary intervention via the right radial artery for the treatment of unstable angina. After the operation she complained of severe pain in the right hand, consistently felt along the median nerve distribution. The nerve conduction study suggested carpal tunnel syndrome. We made a diagnosis of CRPS type II, and the patient received stellate ganglion blockade, cervical epidural blockade, and administration of amitriptyline and loxoprofen. The symptoms gradually improved and her activities of daily living markedly improved. The median nerve appeared to be damaged by local compression and potential ischemia. Careful attention should be paid to avoid CRPS type II, associated with excess compression.

A case of radial arteriovenous fistula during coronary angiography Gorgulu, S. Norgaz, T. Sahingoz, Y. 2013 0 Html Add to my favorites

No abstract available

A case of sheathless transradial coronary intervention for complex coronary lesions with a standard guiding catheter Choi, J., Suh, J., Seo, H. S., Cho, Y. H., Lee, N. H. 2013 0 Html Add to my favorites

One of the major limitations of transradial coronary intervention is the inability to use large guiding system, which leads to the development of dedicated sheathless guide catheter system. However, these devices are not available in the Republic of Korea. We present a case in which conventional guiding catheter was used for sheathless transradial coronary intervention in the treatment of complex coronary anatomy.

A case of transradial carotid stenting in a patient with total occlusion of distal abdominal aorta Yoo B.S., Lee, S. H., Kim, J. Y., Lee, H. H., Ko, J. Y., Lee, B. K., Hwang, S. O., Choe, K. H., Yoon, J. 2002 0 Html Add to my favorites

We report a case with severe carotid stenosis in which carotid stenting was performed via the radial artery due to total occlusion of distal abdominal aorta. The radial approach offers a potential alternative in cases in which the femoral approach is problematic.

A comparative study of bivalirudin plus clopidogrel versus bivalirudin plus prasugrel in primary angioplasty using propensity score matching Díaz De La Llera LS, Cubero Gómez JM, Rangel D, Parejo J, Acosta J, Fernández-Cisnal A, Zafra F, Benezet J. 2013 0 Html Add to my favorites

INTRODUCTION AND OBJECTIVES: In primary angioplasty, bivalirudin is superior to treatment with heparin plus glycoprotein inhibitors for reducing cardiovascular events, although bivalirudin increases the risk of stent thrombosis. Our hypothesis is that the use of prasugrel plus bivalirudin in primary angioplasty would reduce stent thrombosis and cardiovascular events. METHOD: Consecutive patients with acute ST-segment elevation myocardial infarction who were treated by primary angioplasty within 12 hours of the onset of symptoms received bivalirudin plus clopidogrel (Group A) or bivalirudin plus prasugrel (Group B). We compared the groups using propensity score matching. The combined end-point was cardiac death, thrombosis, acute myocardial infarction, and cerebrovascular accident at 30 days. RESULTS: We assessed 168 patients. The approach was preferentially radial (95.7%). No differences in baseline characteristics were observed between Groups A (n = 70) and B (n = 70). The total mortality and rate of major bleeding complications at 30 days were 0% for both of the groups. The rate of acute and subacute thrombosis was 4.3% in Group A and 0% in Group B (P = 0.08). We observed an increased rate of events in Group A (5.7%) versus Group B (0%) (P = 0.042). CONCLUSIONS: The administration of bivalirudin plus prasugrel in primary percutaneous coronary intervention reduces cardiovascular effects compared to bivalirudin plus clopidogrel without increasing major bleeding complications during the first 30 days following primary angioplasty performed with a preferentially radial approach.

A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation: The milan experience Curran, H. Chieffo, A. Buchanan, G. L. Bernelli, C. Montorfano, M. Maisano, F. Latib, A. Maccagni, D. Carlino, M. Figini, F. Cioni, M. Canna, G. L. Covello, R. D. Franco, A. Gerli, C. Alfieri, O. Colombo, A. 2014 0 Html Add to my favorites

OBJECTIVE: To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). BACKGROUND: Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. METHODS: Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. RESULTS: Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4% vs. 7.9%, P = 0.258 and 0% vs. 7.9%, P = 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P = 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P = 0.168 and 13.6% vs. 22%, P = 0.315). CONCLUSION: In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. (c) 2013 Wiley Periodicals, Inc.

A comparison of the radial and the femoral approach in vein graft PCI. A retrospective study Ziakas A., Klinke, P., Mildenberger, R., Fretz, E., Williams, M., Della Siega, A., Kinloch, D., Hilton, D. 2005 0 Html Add to my favorites

BACKGROUND: Transradial PCI is a safe and effective method of percutaneous revascularization. However, there is limited data on the efficacy of the transradial approach for saphenous vein graft (SVG) PCI. METHODS: We studied 334 patients who underwent SVG PCI between January 2000 and December 2003, and compared the radial (132 patients) and the femoral (202 patients) approach. RESULTS: Mean EF (55.6+/-18.6% radial versus 58.1+/-16.8% femoral), lesion location (proximal, mid, distal: 22.6/50.6/26.7% versus 22.6/44.5/32.9% respectively) and lesion type (B1/B2/C: 3.4/4.1/92.5% versus 0.4/3.1/96.5%) were similar in both groups (P>0.05). Five patients had a failed radial attempt (3.8%) and were switched to the femoral approach. Mean fluoroscopy time (20.4+/-12.2 versus 18.4+/-10.2 min), procedural time (60.0+/-27.2 versus 61.6+/-24.9 min) and the use of contrast (223+/-91 versus 234+/-91 ml) IIB/IIIA inhibitors (27.2 versus 33.2%), and stenting (81.5 versus 81.3%) were similar in both groups, whereas 5 or 6 French sheaths were used more often in the radial group (83.4 versus 64.9%, P<0.01). Angiographic success (93.9 versus 92.9%), in hospital MACE (radial:5 MI (3.8%) versus femoral: 1 death (0.5%) and 7 MI (3.5%) and major vascular complications (0.7 versus 0.5%) were also similar. CONCLUSIONS: The radial approach in SVG PCI is as fast and successful as the femoral.

A comparison of the radial and the femoral approaches in primary or rescue percutaneous coronary intervention for acute myocardial infarction in the elderly Ziakas A., Gomma, A., McDonald, J., Klinke, P., Hilton, D. 2007 0 Html Add to my favorites

BACKGROUND: Access site complications are reduced using radial percutaneous coronary intervention (PCI). There is concern that technical difficulties using this approach can delay achievement of reperfusion during primary or rescue PCI for acute myocardial infarction (AMI) especially in elderly patients. METHODS AND RESULTS: We studied 155 patients (pts) > or = 70 years who underwent primary or rescue PCI for AMI,radial (Group1,87 pts) or femoral (Group2,68 pts). Baseline characteristics, the amount of IIB/IIIA inhibitor, contrast and heparin used, and TIMI flow pre and post PCI were similar in both groups (P>0.05). Time from arrival in the catheterization laboratory to the first balloon inflation (Group 1: 44.0+/-21.5 versus Group 2 38.8+/-18.7 min) was also similar, but was significantly longer (61.2+/-11.1 min) compared to both groups in patients with a failed radial approach (7 pts, 8%). Angiographic success, and in-hospital MACE were also similar in the two groups, but vascular access site complications were significantly higher in Group 2 (0 versus 2.9%, P<0.05). CONCLUSION: The use of the radial approach in elderly patients undergoing primary and rescue PCI, when successful, is safe and effective as the femoral approach, and leads to fewer vascular complications.

A comparison of the transradial and the transfemoral approach in chronic total occlusion percutaneous coronary intervention Rathore S., Hakeem, A., Pauriah, M., Roberts, E., Beaumont, A., Morris, J. L. 2009 0 Html Add to my favorites

BACKGROUND: Transradial coronary intervention is a safe and effective method of percutaneous revascularization. Furthermore, the indications for transradial percutaneous coronary intervention (PCI) are expanding. However, there is limited data on the efficacy and the safety of the transradial approach for chronic total occlusion (CTO) PCI. METHODS: We examined 468 patients who underwent CTO PCI between January 2003 and December 2005, and compared the radial (318 patients) and the femoral (150 patients) approach. RESULTS: Baseline demographics, lesion location, and the vessel treated were similar in both groups. Angiographic success was 82% in radial versus 86% in femoral group, P = 0.28, similar in both groups. Total fluoroscopy time (24.49 +/- 13.18 vs. 24.07 +/- 14.12 min, P = 0.36), total procedure time (54.22 +/- 25.35 vs. 60.23 +/- 28.15 min, P = 0.23), and the use of total contrast volume (395.54 +/- 180.25 vs. 406.15 +/- 173.98 ml, P = 0.27) were similar in radial and femoral group, respectively. In hospital MACE [radial: 12 MI (3.8%) vs. femoral: 1 death (0.7%) and 5 MI (3.5%), P = 0.26] were similar in both groups. Access site vascular complications [radial: 11 (3.5%) vs. femoral: 17 (11.3%), P

A complication of coronary angiography in a female patient with systemic sclerosis Dogan, K. Bakx, R. Klemm, P. L. 2011 0 Html Add to my favorites

Systemic sclerosis is an autoimmune connective tissue disorder characterized by microvascular obliterations of the skin, lungs, and heart. Pulmonary hypertension is a potentially life-threatening complication of systemic sclerosis and coronary angiography is indicated for diagnosing this complication. A 79-year-old woman, who suffered from systemic sclerosis and Raynaud’s syndrome, presented with a cold, painful, ulcerated right hand. It appeared that arterial occlusion of the radial artery had occurred following coronary angiography. Symptoms initially worsened, but improved following treatment with bosentan. This complication could have been avoided by performing the coronary angiography via the femoral artery. This case study emphasises the importance of taking medical history and comorbidities into account when carrying out invasive diagnostic procedures.

A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011 Dehmer, G. J. Weaver, D. Roe, M. T. Milford-Beland, S. Fitzgerald, S. Hermann, A. Messenger, J. Moussa, I. Garratt, K. Rumsfeld, J. Brindis, R. G. 2012 0 Html Add to my favorites

OBJECTIVES: This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry. BACKGROUND: The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratories in the United States. METHODS: Data were summarized for 6 consecutive calendar quarters beginning January 1, 2010, and ending June 30, 2011. This report includes 1,110,150 patients undergoing only diagnostic cardiac catheterization and 941,248 undergoing percutaneous coronary intervention (PCI). RESULTS: Some notable findings include, for example, that on-site cardiac surgery was not available in 83% of facilities performing fewer than 200 PCIs annually, with these facilities representing 32.6% of the facilities reporting, but performing only 12.4% of the PCIs in this data sample. Patients 65 years of age or older represented 38.7% of those undergoing PCI, with 12.3% being 80 years of age or older. Almost 80% of PCI patients were overweight (body mass index >/=25 kg/m(2)), 80% had dyslipidemia, and 27.6% were current or recent smokers. Among patients undergoing elective PCI, 52% underwent a stress study before the procedure, with stress myocardial perfusion being used most frequently. Calcium scores and coronary computed tomography angiography were used very infrequently (<3%) before diagnostic or PCI procedures. Radial artery access was used in 8.3% of diagnostic and 6.9% of PCI procedures. Primary PCI was performed with a median door-to-balloon time of 64.5 min for nontransfer patients and 121 min for transfer patients. In-hospital risk-adjusted mortality in ST-segment elevation myocardial infarction patients was 5.2% in this sample. CONCLUSIONS: Data from the CathPCI Registry provide a contemporary view of the current practice of invasive cardiology in the United States.

A coronary artery stent–in the radial artery! Begum, S. S. Momin, A. U. Shipolini, A. 2011 0 Html Add to my favorites

No abstract available

A fingertip-mounted ultrasound probe to guide radial artery access: The SonicEye® Device Bertrand OF - AIMRADIAL 2013 - SonicEye ultrasound 09/28/2013 1 Slideshare Add to my favorites
A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention Smith E.J., Reitan, O., Keeble, T., Dixon, K., Rothman, M. T. 2009 0 Html Add to my favorites

OBJECTIVES: To investigate the safety of a novel percutaneous circulatory support device during high-risk percutaneous coronary intervention (PCI). BACKGROUND: The Reitan catheter pump (RCP) consists of a catheter-mounted pump-head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. METHODS: Ten consecutive patients requiring circulatory support underwent PCI,mean age 71 +/- 9,LVEF 34% +/- 11%,jeopardy score 8 +/- 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose sutures. PCI was performed via the radial artery. Outcomes included in-hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. RESULTS: The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 +/- 1,424 rpm maintained an aortic gradient of 9.8 +/- 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 +/- 2.4 mg/dl pre vs. 11.9 +/- 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 +/- 74 x 10(9) vs. 245 +/- 63, P = NS). Renal function improved (cre pre 110 +/- 27 micromol/l vs. 99 +/- 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. CONCLUSIONS: The RCP can be used safely in high-risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed.

A late complication of percutaneous radial artery cannulation Nazeri, A. Sohawon, S. Papadopoulou, B. Georgala, A. Dernier, Y. Noordally, S. O. 2011 0 Html Add to my favorites

Radial artery pseudoaneurysms occurring as a late complication of percutaneous radial artery cannulation are rare, while those which are infected are exceptional. Known risk factors are age-related with patients being in their seventies and onwards, the duration of the radial artery catheter and staphylococcal catheter-related infections. We report the case of an 82-year-old patient who developed a mycotic radial artery pseudoaneurysm as a late complication of arterial catheterization.

A morphological study of variations in the branching pattern and termination of the radial artery Gupta, C. Ray, B. Dsouza, A. S. Nair, N. Pai, S. R. Manju, M. 2012 0 Html Add to my favorites

INTRODUCTION: Coronary artery bypass grafting is an established means of treating advanced coronary artery disease. In recent years, there has been an increased interest in the radial artery as an entry route during coronary angiography. Accurate knowledge of the branching pattern of this artery and its relation to surrounding structures is of great importance in the care of surgical patients. METHODS: This study was conducted on 75 formalin-fixed upper limbs in order to note the variations in the branching pattern and termination of the radial artery. RESULTS: The radial artery divided into three branches in 2.7% of cases and into two branches in 52.0% of cases. The radial recurrent artery originated from the brachial artery instead of the radial artery in 12.0% of cases. The radial recurrent artery, palmar carpal artery, first dorsal metacarpal artery and superficial palmar artery were absent in 1.3%, 26.7%, 9.3% and 5.3% of cases, respectively. 6.7% of cases had a high origin of the superficial palmar artery. CONCLUSION: The rich photographic documentation of the variation of branching pattern and termination of radial artery is not only of academic interest but also useful to surgeons and radiologists working in the same area.

A new 0.010-inch guidewire and compatible balloon catheter system: the IKATEN registry Matsukage T., Yoshimachi, F., Masutani, M., Katsuki, T., Saito, S., Takahashi, A., Iida, K., Katahira, Y., Michishita, I., Tanabe, K., Kan, Y., Ikari, Y. 2009 0 Html Add to my favorites

OBJECTIVE: To evaluate the safety and feasibility of a new 0.010-inch guidewire and a specialized balloon catheter for the 0.010-inch guidewire in routine percutaneous coronary intervention (PCI). BACKGROUND: Several reports have shown that a new 0.010-inch system is effective for specific situations where reduction of catheter size may be necessary. However, the safety of this system in routine PCI is unknown. METHODS: The IKATEN registry is a prospective, multicenter, nonrandomized registry study. Patients who underwent elective PCI with a 0.010-inch guidewire and its associated balloon catheter as primary devices were enrolled. The coprimary endpoints were clinical success and device success rates. The secondary endpoints were major adverse cardiac events (MACE) and bleeding complications. RESULTS: A total of 133 patients with 148 lesions were enrolled. The majority were male (75.3%), and mean age was 68 +/- 10 years. Type B2/C lesions comprised 60% of the lesions, prevalence of chronic total occlusion (CTO) was 16.9%, and bifurcation lesions were found in 22.3% of patients. A transradial approach was used in 79.7% of patients, and the average guiding catheter size was 5.1 +/- 0.4 Fr. Clinical success rate was 99.2%, and device success rate was 99.3%. Device failure occurred only in one case of chronic total occlusion because of unsuccessful guidewire passage. No MACE or bleeding complications were reported except for a small hematoma at the puncture site in one patient. Stent delivery success rate on 0.010-inch guidewire was 93.9% because of failure of stent balloon to pass eight lesions. CONCLUSION: The IKATEN registry data suggest that the 0.010-inch system is safe and its use is feasible in routine PCI including bifurcation and CTO lesions.

A new miniature catheter with side-holes for percutaneous transradial or transbrachial coronary angiography Ootomo T., Meguro, T., Endoh, N., Terashima, M., Ito, Y., Abe, S., Ogata, K., Fujiwara, S., Honda, H., Kuhara, R., Miyazaki, Y., Kawashima, O., Isoyama, S. 2002 0 Html Add to my favorites

The percutaneous arm approach through the radial or brachial artery for diagnostic cardiac catheterization has advantages, such as a lower incidence of access-site complications and decreased patient discomfort, particularly when smaller diameter catheters are employed. However, the pressure produced by high-flow jets of contrast material exiting from an end-hole against the vascular wall can cause coronary dissection or myocardial blushing. To avoid this type of complication, we designed and developed a new miniature (4 French) catheter with two side-holes for coronary angiography. Under conditions similar to those of a clinical situation, we obtained the relationship between the pressure produced by the jets exiting from an end-hole and the force with which the tip of the catheter was pushed against the vascular wall. The presence of the side-holes substantially decreased the pressure at forces ranging between 0 and 15 gf, and at all injection rates (2.0 3.5 ml/second), but their location did not affect the pressure. In a preliminary clinical study, the new catheters with side-holes were feasible and effective for coronary angiography through the radial artery. Furthermore, the distribution of contrast material decreased the incidence of dislodgement of the catheter from the coronary ostia and enabled good visualization of the coronary ostia and proximal branches.

A new operative classification of both anatomic vascular variants and physiopathologic conditions affecting transradial cardiovascular procedures Burzotta F., Trani, C., De Vita, M., Crea, F. 2010 0 Html Add to my favorites

Transradial approach is known to reduce access-site complications of coronary procedures. However, the diffusion of transradial approach in the interventional cardiology community is limited by its higher failure rate compared to transfemoral. Transradial approach failures are mainly caused by a series of anatomic variants which may be encountered in the upper limb arteries. Such anatomic variants have been variously classified based on postmortem studies or systematic angiographic studies. We propose a simplified “operative” classification of anatomic vascular variants and physiopathologic conditions of the arterial axis, from radial to aortic root, possibly affecting transradial cardiovascular procedures.

A new technique for bilateral angiography in a single radial access Zhang, B. Wang, F. Liao, H. T. Jin, L. J. Yan, H. Dong, T. M. Wu, H. D. Yu, H. M. 2013 0 Html Add to my favorites

OBJECTIVE: To develop a new technique of bilateral angiography in a single radial access (BASiRalA) which can reduce a puncture site. METHODS: From March 2011 to February 2012, 13 cases of coronary heart disease patients with chronic total occlusion (CTO) were treated (6 CTOs in right coronary artery and 7 in left anterior descending artery). All patients underwent percutaneous coronary intervention (PCI) via the right radial artery access and 6 F guiding catheters were delivered to the diseased artery. Once the wires crossed the CTO lesions and were uncertain if the wires were in true lumen or not, BASiRalA was performed. The Finecross microcatheters were advanced out of the 6 F guiding catheter, then withdraw 6F guiding catheter to the opening of diseased artery, the soft wires were manipulated into the middle portion of opposite coronary artery. After that, the microcatheters were advanced to this segment or the branches relative to the collateral vessels connected with CTOs. After pulling out the wires, microcatheter injections can be performed for contralateral angiography. BASiRalA related complications were observed after the procedure. RESULTS: BASiRalA technique was applied to 13 CTOs and 10 procedures succeeded (76.92%). BASiRalA failed in 3 cases and the wires and microcatheters could not be advanced to the opposite coronary arteries within 20 minutes. Alternatively, contralateral angiography via femoral arteries was performed in these 3 patients. The average time of BASiRalA technique was 7 (5 – 13) minutes and the shortest time of wires crossing to the opposite coronary artery was 5 seconds. There was no procedure induced complication during procedure or post procedure. CONCLUSION: BASiRalA technique is feasible in treating CTO patients by PCI.

A new vascular closure device for the transradial approach: the D Stat Radial system von Korn H., Ohlow, M. A., Yu, J., Huegl, B., Schulte, W., Wagner, A., Haberl, K., Gruene, S., Lauer, B. 2008 0 Html Add to my favorites

BACKGROUND: The transradial approach is associated with low complication rates. The D Stat Radial vascular closure system offers hemostatic pressure locally at the puncture site with residual venous flow. METHODS: We prospectively included 113 consecutive patients presenting between August 2006 and December 2006. Diagnostic coronary procedures were performed using 4 Fr or 5 Fr sheaths, while 6 Fr devices were used for PCI. In every case at least 5.000 IU heparin was given. Compression with the retention strap was planned for approximately 3 hours before the pad was fixed using a medical strip. All data were entered into a database after a two-dimensional ultrasound examination study of the puncture site. RESULTS: The mean age was 65 years (+/-SD 10.3), with 62% being male. Patients presenting with acute coronary syndrome amounted to 6.2%, where 5r F sheaths were usually used with these patients (64.6%). PCI was carried out in 21.2% of cases. The system was applied successfully in all patients. The mean duration of compression was 4.6 hours (+/-SD 1.4). Bleeding after removal of the system occurred in 18.6% of cases, which resulted in prolonged compression in 17.7%. A hematoma >5 cm was seen in 4.4% of the sample. Ultrasound examinations revealed closure of the radial artery in 6.2%. CONCLUSIONS: We conclude that this new device operates efficiently, but bleeding occurred in 18.6%. Compression time should be extended to 6 hours.

A novel lead attenuator to reduce operator exposure to scattered radiation in transradial coronary procedures Osherov, A. B. Seidelin, P. Wolff, R. Wright, G. A. Strauss, B. H. Robert, N. 2013 0 Html Add to my favorites

No abstract available

A novel technique of chronic total occlusion retrograde wire crossing by wiring into the antegrade microcatheter Liu W., Wagatsuma, K. 2010 0 Html Add to my favorites

We described a novel transradial retrograde wiring technique to treat chronic total occlusion (CTO) of the left anterior descending artery. When both retrograde wire and kissing wire technique failed to cross the CTO lesion, an antegrade microcatheter was placed in the CTO lesion. Then, a retrograde wire was manipulated into the antegrade microcatheter and subsequently exchanged and wire externalized. This technique appears to be feasible and safe alternative for retrograde wire crossing of the CTO lesion. It is a less traumatic modified version of controlled antegrade and retrograde subintimal tracking (CART) technique that can be attempted before embarking on CART or reverse CART strategy. (c) 2010 Wiley-Liss, Inc.

A prospective randomized trial of radial vs. femoral access in patients with ST-segment elevation myocardial infarction; 1 year results Bernat I - AIMRADIAL 2013 - STEMI-RADIAL trial 09/27/2013 0 Slideshare Add to my favorites
A quarter century & change of directions: femoral to radial approach? Parikh, K. H. 2010 0 Html Add to my favorites
A randomised comparison of transradial and transfemoral approach for carotid artery stenting: RADCAR study (RADial access for CARotid artery stenting) Ruzsa Z - AIMRADIAL 2014 Endovascular - Carotid artery stenting 10/24/2014 0 Slideshare Add to my favorites
A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study Kiemeneij F., Laarman, G. J., Odekerken, D., Slagboom, T., van der Wieken, R. 1997 0 Html Add to my favorites

OBJECTIVES: This study sought to compare procedural and clinical outcomes of percutaneous transluminal coronary angioplasty (PTCA) performed with 6F guiding catheters introduced through the radial, brachial or femoral arteries. BACKGROUND: Transradial PTCA has been demonstrated to be an effective and safe alternative to transfemoral PTCA,however, no randomized data are currently available. METHODS: A randomized comparison between transradial, transbrachial and transfemoral PTCA with 6F guiding catheters was performed in 900 patients. Primary end points were entry site and angioplasty related. Secondary end points were quantitative coronary analysis after PTCA, procedural and fluoroscopy times, consumption of angioplasty equipment and length of hospital stay. RESULTS: Successful coronary cannulation was achieved in 279 (93.0%), 287 (95.7%) and 299 (99.7%) patients randomized to undergo PTCA by the radial, brachial and femoral approaches, respectively. PTCA success was achieved in 91.7%, 90.7% and 90.7% (p = NS) of patients, with 88.0%, 87.7% and 90.0% event free at 1-month follow-up, respectively (p = NS). Major entry site complications were encountered in seven patients (2.3%) in the transbrachial group, six (2.0%) in the transfemoral group and none in the transradial group (p = 0.035). Transradial PTCA led to asymptomatic loss of radial pulsations in nine patients (3%). Procedural and fluoroscopy times were similar, as were consumption of guiding and balloon catheters and length of hospital stay ([mean +/- SD] 1.5 +/- 2.5, 1.8 +/- 3.8 and 1.8 +/- 4.2 days, respectively). CONCLUSIONS: With experience, procedural and clinical outcomes of PTCA were similar for the three subgroups, but access failure is more common during transradial PTCA. Major access site complications were more frequently encountered after transbrachial and transfemoral PTCA.

A Randomized Comparison of Radial vs. Femoral Access for Coronary Intervention in ACS (the RIVAL Trial) Jolly SS 2011 0 Slideshare Add to my favorites
A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention) Michael, T. T. Alomar, M. Papayannis, A. Mogabgab, O. Patel, V. G. Rangan, B. V. Luna, M. Hastings, J. L. Grodin, J. Abdullah, S. Banerjee, S. Brilakis, E. S. 2013 0 Html Add to my favorites

OBJECTIVES: This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery. BACKGROUND: Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery. METHODS: Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat. RESULTS: Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 +/- 39 ml vs. 171 +/- 72 ml, p < 0.01), longer procedure time (21.9 +/- 6.8 min vs. 34.2 +/- 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 +/- 0.54 Gy vs. 1.29 +/- 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 +/- 1.0 mrem vs. 2.6 +/- 1.7 mrem, p < 0.01; second operator 0.8 +/- 1.1 mrem vs. 1.8 +/- 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%). CONCLUSIONS: In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).

A randomized comparison of TR band and radistop hemostatic compression devices after transradial coronary intervention Rathore S., Stables, R. H., Pauriah, M., Hakeem, A., Mills, J. D., Palmer, N. D., Perry, R. A., Morris, J. L. 2010 0 Html Add to my favorites

BACKGROUND: The transradial route for coronary intervention has proven to be safe, effective, and widely applicable in different clinical situations. Several compressive hemostatic devices have been introduced that have shown to be safe and are effective in achieving hemostasis. METHODS: Seven hundred ninety patients were randomly assigned to receive either TR band or Radistop hemostatic compression devices after transradial coronary procedure. The outcome measures were patient tolerance of the device, local vascular complications, and the time taken to achieve hemostasis. RESULTS: The mean age was 62.88 years, and 74.2% of the patients were men. Patient age, height, weight, wrist circumference, body mass index, male sex, hypertension, diabetes, hypercholesterolemia, and smoking incidences were similar in both groups. There were significantly more patients reporting no discomfort in the TR band group compared to the Radistop group (77% vs. 61%,P = 0.0001). Patients in the Radistop group reported significantly more pain across all categories of severity and three patients in the Radistop group were crossed over to TR band because of severe discomfort. Oozing and ecchymosis were seen in about 16% of the patients. Local small hematoma and large hematoma were seen in 5.4% and 2.2% patients respectively, and similar in both groups. Radial artery occlusion at the time of discharge was seen in 9.2% of the patients though only 6.8% showed persistent occlusion at the time of follow-up. The time taken to achieve hemostasis was significantly longer in the TR Band group (5.32 +/- 2.29 vs. 4.83 +/- 2.23 hr,P = 0.004). There was significantly higher incidence of radial artery occlusion in patients with smaller wrist circumference, the patients who experienced radial artery spasm during the procedure, and patients with no heparin administration during the procedure. CONCLUSIONS: We have shown in a randomized comparison of Radistop and TR band that both devices are safe and effective as hemostatic compression devices following transradial procedures. However, more patients felt discomfort with the Radistop device and the time taken to achieve hemostasis was longer with TR band. (c) 2010 Wiley-Liss, Inc.

A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty Brueck M., Bandorski, D., Kramer, W., Wieczorek, M., Holtgen, R., Tillmanns, H. 2009 0 Html Add to my favorites

OBJECTIVES: The aim of the study was to evaluate the safety, feasibility, and procedural variables by the transradial approach compared with the transfemoral access in a standard population of patients undergoing coronary catheterization. BACKGROUND: Coronary catheterization is usually performed via the transfemoral approach. Transradial access may offer some advantages in comparison with transfemoral access especially under conditions of aggressive anticoagulation and antiplatelet treatment. METHODS: Between July 2006 and January 2008, a total of 1,024 patients undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Patients with an abnormal Allen’s test, history of coronary artery bypass surgery, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded. RESULTS: Successful catheterization was achieved in 494 of 512 patients (96.5%) in the transradial and in 511 of 512 patients (99.8%) in the transfemoral group (p < 0.0001). Median procedural duration (37.0 min, interquartile range [IQR] 19.6 to 49.1 min vs. 40.2 min, IQR 24.3 to 50.8 min,p = 0.046) and median dose area product (38.2 Gycm(2), IQR 20.4 to 48.5 Gycm(2) vs. 41.9 Gycm(2), IQR 22.6 to 52.2 Gycm(2),p = 0.034) were significantly lower in the transfemoral group compared with the transradial access group. A median amount of contrast agent was similar among both groups. Vascular access site complications were higher in the transfemoral group (3.71%) than in the transradial group (0.58%,p = 0.0008) CONCLUSIONS: The findings of the present study show that transradial coronary angiography and angioplasty are safe, feasible, and effective with similar results to those of the transfemoral approach. However, procedural duration and radiation exposure are higher using the transradial access. In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.

A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation Bertrand O.F., De Larochelliere, R., Rodes-Cabau, J., Proulx, G., Gleeton, O., Nguyen, C. M., Dery, J. P., Barbeau, G., Noel, B., Larose, E., Poirier, P., Roy, L. 2006 0 Html Add to my favorites

BACKGROUND: Systematic use of coronary stents and optimized platelet aggregation inhibition has greatly improved the short-term results of percutaneous coronary interventions. Transradial percutaneous coronary interventions have been associated with a low risk of bleeding complications. It is unknown whether moderate- and high-risk patients can be discharged safely the same day after uncomplicated transradial percutaneous coronary interventions. METHODS AND RESULTS: We randomized 1005 patients after a bolus of abciximab and uncomplicated transradial percutaneous coronary stent implantation either to same-day home discharge and no infusion of abciximab (group 1, n=504) or to overnight hospitalization and a standard 12-hour infusion of abciximab (group 2, n=501). The primary composite end point of the study was the 30-day incidence of any of the following events: death, myocardial infarction, urgent revascularization, major bleeding, repeat hospitalization, access site complications, and severe thrombocytopenia. The noninferiority of same-day home discharge and bolus of abciximab only compared with overnight hospitalization and abciximab bolus and infusion was evaluated. Two thirds of patients presented with unstable angina and approximately 20% presented with high-risk acute coronary syndrome prior to the procedure. The incidence of the primary end point was 20.4% in group 1 and 18.2% in group 2 (P=0.017 for noninferiority) with a troponin T-based definition of myocardial infarction,the incidence of the primary end point was 11.1% in group 1 and 9.6% in group 2 (P=0.0004 for noninferiority) with a creatinine kinase myocardial band-based definition of myocardial infarction. No death occurred. Rate of major bleeding in both groups was extremely low at 0.8% and 0.2%, respectively. From 504 patients randomized in group 1, 88% were discharged home the same day. CONCLUSIONS: Our data suggest that same-day home discharge after uncomplicated transradial coronary stenting and bolus only of abciximab is not clinically inferior, in a wide spectrum of patients, to the standard overnight hospitalization and a bolus followed by a 12-hour infusion. This novel approach offers a safe strategy for same-day home discharge after uncomplicated coronary intervention.

A randomized study comparing the effectiveness of right and left radial approach for coronary angiography Norgaz, T. Gorgulu, S. Dagdelen, S. 2012 0 Html Add to my favorites

OBJECTIVES: Our aim was to compare the effectiveness between right radial approach (RRA) and left radial approach (LRA) by means of a randomized study in a large unselected patient population undergoing diagnostic coronary angiography. METHODS: Totally, 1,000 patients were randomized to undergo to RRA (n = 500) or LRA (n = 500). Procedure success was defined as coronary angiography completed with the initial radial artery approach without changing to another route. Performance of the procedure: Total procedural duration, the number of catheters and guidewires used were recorded. Safety of the procedure: The parameters collected for radiation exposure were dose area product (DAP) and fluoroscopy time. RESULTS: The percentage of success was not different between the two aproaches (LRA, 94.0%; RRA,93.8%; P = 0.96). The crossover rate to femoral was low, accounting for 38 cases (3.8%), without differences between RRA and LRA (20 and 18 cases, respectively, P > 0.05). An almost triple incidence of operator-reported subclavian tortuosity in the RRA compared with LRA was observed (44 cases vs. 15 cases, P < 0.001). With respect to the total procedural duration there was no difference between those two aproaches (LRA, 8.54 +/- 4.09 min vs. RRA, 8.63 +/- 5.20; P = 0.772). However, the fluoroscopy time was significantly shorter via the LRA compared with RRA (2.76 +/- 2.00 min vs. 3.08 +/- 2.62 min; P = 0.029). CONCLUSIONS: LRA for coronary angiography is associated with the same success rate and procedural duration time compared with RRA. However, the fluoroscopy time is significantly shorter in favor of LRA.

A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions Dahm J.B., Vogelgesang, D., Hummel, A., Staudt, A., Volzke, H., Felix, S. B. 2002 0 Html Add to my favorites

Transradial coronary interventions (TCI) are occasionally limited by radial spasms and postprocedural radial occlusions, which are related to the radial diameter and which possibly may be reduced by the use of smaller guiding catheter. However, 5 Fr, 0.058″ lumen diameter guiding catheter affords less strength, visibility, and backup. In a randomized study, we investigated procedural and clinical success and vascular access complications of 5 Fr in comparison to 6 Fr guiding catheter. One hundred seventy-one patients with coronary lesions suitable for at least 5 Fr transradial approach (i.e., normal Allen test, only balloon angioplasty and stent) were randomly assigned for 5 or 6 Fr TCI. The primary combined endpoint was procedural and clinical success, and secondary endpoints were vascular access complications and the occurrence of postprocedural radial occlusions at 1-month follow-up. Procedural success was achieved in 95.4% of 5 Fr and 92.9% of 6 Fr patients. Selective cannulation of the coronary ostium failed in 1.1% of 5 Fr and 4.8% of 6 Fr patients (P = 0.08). Minor hematomas without need for surgical repair or blood transfusions occurred in 1.1% (5 Fr) and 4.8% (6 Fr,P = 0.07),1.1% of 5 Fr and 5.9% of 6 Fr patients (P = 0.05) suffered loss of radial pulse due to radial occlusion. Selected noncomplex coronary lesions can successfully and safely be treated either with 5 or 6 Fr guiding catheters. A tendency of higher procedural success rates and lower vascular access complications was documented after 5 Fr in comparison to 6 Fr TCI. This was particularly the case among patients with small radial diameters.

A Randomized Trial of Radial vs Femoral Approaches for Primary PCI Bernat I 2011 0 Slideshare Add to my favorites
A rare anomaly of the aortic arch: aberrant right subclavian artery associated with common carotid trunk Cummings, M. S. Kuo, B. T. Ziada, K. M. 2011 0 Html Add to my favorites

With increasing use of transradial access (TRA) to perform coronary angiography, arterial anomalies of the upper extremity are more frequently encountered. We describe a patient with an aberrant right subclavian artery (RSCA) originating as the last major branch of the aortic arch, which eventually led to failure of the transradial approach. Subsequent arch aortography revealed an associated common carotid trunk. The combination of both anomalies is a rare finding and may be associated with a number of other arterial and/or mediastinal organ anomalies.

A rare case of radial arteriovenous fistula after coronary angiography Kwac, M. S. Yoon, S. J. Oh, S. J. Jeon, D. W. Kim, D. H. Yang, J. Y. 2010 0 Html Add to my favorites

The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Local vascular complications following angioplasty are seen in 5% to 10% of patients, especially in those who need prolonged anticoagulation. Transradial access for coronary procedures dramatically reduces access site complications. We report a rare case of radial arteriovenous fistula, which developed after coronary angiography perfomed using the transradial approach.

A rare complication of radial artery catheterization Inan, M. B. Acikgoz, B. Yazicioglu, L. Kaya, B. Ozyurda, U. 2011 0 Html Add to my favorites

An arterial pseudoaneurysm is a cavity which does not consist of three layers of arterial wall and is generally seen at femoral and radial artery sites due to bone fractures, arterial injuries and iatrogenic reasons such as catheterization. The treatment choice may be either surgical or conservative. Patients with pseudoaneurysm should be carefully followed and the treatment choice should be immediately decided to avoid possible complications. We report a case of pseudoaneurysm formation in the radial artery that occurred one week after arterial catheterization for coronary angiography. The treatment choice for this patient was surgical and he was discharged without any complications.

A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches In Women Undergoing Percutaneous Coronary Intervention: The Study of Access Enhancement of PCI for Women (SAFE-PCI for Women) Trial Rao SV 2014 06/30/2014 0 Slideshare Add to my favorites
A review of radiation exposures associated with radial cardiac catheterisation Park, E. Y. Shroff, A. R. Crisco, L. V. Vidovich, M. I. 2013 0 Html Add to my favorites

Transradial (TR) cardiac catheterisation is thought to be associated with an increased exposure to radiation compared with the traditional transfemoral (TF) access. This paper provides a review of current literature describing these reported associations. Although several studies have reported an increase in radiation exposure to both operator and patient with TR compared with TF access, others have reported findings suggesting no significant difference, even reporting decreased exposure with TR access. Ultimately, increased radiation exposure appears likely with TR access; however, in consideration of the many benefits associated with TR access, radiation exposure remains only one of many considerations when deciding between routes of access.

A right radial artery false aneurysm Hyde T.A., Ramcharitar, S., Singh-Ranger, R. 2010 0 Html Add to my favorites
A simple and effective regimen for prevention of radial artery spasm during coronary catheterization Chen C.W., Lin, C. L., Lin, T. K., Lin, C. D. 2006 0 Html Add to my favorites

Radial artery spasm occurs frequently during the transradial approach for coronary catheterization. Premedications with nitroglycerin and verapamil have been documented to be effective in preventing radial spasms. Verapamil is relatively contraindicated for some patients with left ventricular dysfunction, hypotension and bradycardia. We would like to know whether nitroglycerin alone is sufficient for the prevention of radial artery spasm. We conducted a randomized controlled trial to compare the spasmolytic effect between heparin alone, heparin plus nitroglycerin and heparin plus nitroglycerin and varapamil during transradial cardiac catheterization. In this study, a total of 406 patients underwent transradial cardiac catheterization and intervention. After successful cannulation and sheath insertion of radial arteries, 133 patients in group A received 3,000 units of heparin, 100 microg of nitroglycerin and 1.25 mg of verapamil via sheath, 135 patients in group B received 3,000 units of heparin and 100 microg of nitroglycerin, and 93 patients in group C received 3,000 units of heparin. Five patients in group A (3.8%), 6 patients in group B (4.4%) and 19 patients in group C (20.4%) showed radial spasms. There is no statistically significant difference between groups A and B (p = 0.804), but there are strong statistically significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.003). Intra-arterial premedication with 100 microg nitroglycerin and 3,000 units of heparin is effective in preventing radial spasms during transradial cardiac catheterization.

A simple approach for the reduction of knotted coronary catheter in the radial artery during the transradial approach Patel, T. Shah, S. Pancholy, S. 2011 0 Html Add to my favorites

Development of a catheter knot is uncommon but still a matter of concern for a catheterizing cardiologist. There are only a few case reports of percutaneous catheter unknotting in the literature. We describe for the first time a case of catheter unknotting in a radial artery using a simple technique via the transradial approach. We concluded that percutaneous catheter unknotting in a radial artery using basic and simple hardware is a good alternative option to surgical management.

A simple approach for the reduction of knotted coronary catheters during transradial coronary angiography Zhang D, Jia E, Chen J, Xu L, Yang Z, Li C 2014 0 Html Add to my favorites

In some cases, catheters can become entrapped looped/kinked during transradial catheterization in the brachial artery. Regular maneuvers and manipulations to disengage the catheter might be unsuccessful due to the narrow diameter of the artery. We present two cases of coronary angiography complicated by right coronary catheter knotting and present a simple approach for their reduction in the brachial artery using the Amplatz GooseNeck Snare.

A single center experience with same-day transradial-PCI patients: a contrast with published guidelines Gilchrist, I. C. Rhodes, D. A. Zimmerman, H. E. 2012 0 Html Add to my favorites

OBJECTIVES: Our goal was to compare recently published Consensus Statement from the SCAI/ACC on appropriateness for same-day PCI with patient characteristics from a real-world same-day PCI experience in the United States. BACKGROUND: Recent practice statement published by the SCAI /ACC in 2009 describes patients suitable for outpatient PCI procedures. Whether this practice statement reflects actual real-world practice in the setting of advances in transradial catheterization needs further exploration. METHODS: Pre-existing, deidentified, quality assurance data from 100 sequential patients undergoing transradial PCI, and same-day discharge were compared with criteria in SCAI/ACC statement on outpatient PCI. Each had been identified post-PCI as uncomplicated and therefore eligible for same day discharged. Specific attention was placed on whether the patients carried any exclusion to same-day discharge. RESULTS: One hundred six procedures were recorded in 100 patients including 11 women and 89 men, median age 62 (55,71) years all with stable ischemia. Early follow up was done for medication compliance. None were readmitted nor had post-PCI complications. Only 15% met appropriateness criteria for same-day discharge. Older age, distance from the hospital, greater than simple PCI, and the need for specific antiplatelet therapy represented the dominant contraindications to discharge. CONCLUSIONS: Using transradial approaches and structured early follow up by advance practice nurses, same-day discharge can be accomplished successfully in a broad range of patients outside of those suggested by the SCAI/ACC 2009 Consensus Document. Confirmation of these results could result in shorter hospitalizations for US patients and align advances in catheterization technology to optimize heath care delivery.

A single center multioperator initial experience of 4,195 patients at a primary radial intervention program in a tertiary level center Gokhroo RK, Kaushik SK, Padmanabhan D, Bisht D, Gupta S 2014 0 Html Add to my favorites

BACKGROUND: There has been an increase the acceptability and the number of the procedures via the radial approach. We present our experience pertaining to the clinical characteristics, procedural details and post procedural outcome of patients undergoing radial artery access, coronary angiographies over a period of 4 years at a primary care tertiary level center. MATERIALS AND METHODS: A retrospective analysis of all the coronary artery procedures during the last 4 years was done and the various parameters related to these procedures noted. RESULTS: In 4195 procedures performed, success in radial artery procedures was achieved in 3975 (94.8%) procedures. The average puncture time and total procedure time was 9.5 + 3 min (min) and 15 + 2.5 min in the initial 500 patients, whereas the times taken in the final 695 patients were just 1.5 + 0.5 min and 3.0 + 1.5 min respectively. The total fluoroscopy time was not significantly different among the groups, when performed by an operator with training in the femoral route for angiography. Cardiology fellows needed more fluoroscopy time when mastering the radial route. Crossover of access sites was seen in 220 patients (5.2%). CONCLUSIONS: After 100 procedures, radial access coronary angiographies take less than 4.5 min, with first attempt radial artery access and negligible complication rates. Prior experience of coronary angiography helps in the reduction of fluoroscopy time during the learning curve.

A single transradial guiding catheter for right and left coronary angiography and intervention Youssef A.A., Hsieh, Y. K., Cheng, C. I., Wu, C. J. 2008 0 Html Add to my favorites

Aims: There is no data about the utilisation of a single guiding catheter for current routine, transradial, right and left coronary diagnosis and intervention. We investigated the feasibility and safety of using 6Fr, Ikari left (IL) 3.5 guiding catheter for this purpose. Methods and results: This prospective single-centre study enrolled 621 consecutive patients referred for transradial coronary angiography with ad hoc coronary intervention. The radial artery was successfully accessed in 96.8% of patients. Right and left coronaries were successfully engaged in 98.1% of cases. Engagement with good back-up at right and left coronaries (device success) was achieved in 96.6% of cases. Coronary intervention was performed in 61.2% of the cases, among them, 84.5% had coronary stenting. Procedure success was 98.2%. Procedure time was 21.4+/-15.1 and 65.4+/-36.1 minutes,mean fluoroscopy time was 6.8+/-7.2 and 24.1+/-18.9 minutes and mean contrast volume was 96.2+/-45.3 and 197.9+/-46.2 ml for diagnostic and interventional cases respectively. One patient (0.16%) had catheter related radial artery spasm and three patients (0.48%) encountered a catheter induced RCA dissection. Conclusions: Right and left coronary angiography and intervention is feasible and highly successful using IL 3.5 as a single transradial guiding catheter.

A single-center experience of transitioning from a routine transfemoral to a transradial intervention approach in ST-elevation myocardial infarction: Impact on door-to-balloon time and clinical outcomes Kajiya, T. Agahari, F. Wai, K. L. Tai, B. C. Lee, C. H. Chan, K. H. Teo, S. G. Richards, A. M. Tan, H. C. Low, A. F. Chan, M. Y. 2013 0 Html Add to my favorites

BACKGROUND: In the emergent setting of ST-elevation myocardial infarction (STEMI), transradial intervention (TRI) is less frequently employed than transfemoral intervention (TFI). Because of the greater technical complexity of TRI, a potential compromise in door-to-balloon (DTB) time remains a major concern of centers adopting TRI for STEMI. METHODS: We performed a propensity-matched analysis, with 1:1 matching of TRI and TFI patients comparing DTB time, 30-day major adverse cardiac event (MACE), and bleeding outcomes of 1052 consecutive STEMI patients managed at our center during a 2-year transition program from routine TFI to TRI access for STEMI. RESULTS: From January 2008 to April 2010, 359 (34.1%) STEMI patients underwent TRI and the remaining 693 (65.9%) STEMI patients underwent TFI. In 283 propensity score matched pairs of TRI and TFI patients, TRI was associated with shorter DTB time (63.6min vs 69.4min, p=0.027) and more patients having DTB time<90min (88.3% vs 82.3%, p=0.043). Thirty-day MACE occurred in 1.0% in the TRI group and 3.0% in the TFI group (p=0.129). There was no significant difference in major (p=0.313) or minor bleeding (p=0.714) between the TRI and TFI groups. There was a twofold greater use of glycoprotein (GP) IIb/IIIa inhibitor in the TRI group (68.5%) compared with the TFI group (36.4%) (p<0.001). CONCLUSION: Compared with TFI, TRI was not associated with longer DTB time during our center’s transition from routine TFI to TRI in STEMI. Our experience suggests that the transition to TRI in STEMI can be safely achieved with DTB times that are comparable and possibly better than propensity-matched TFI cases.

A strategy to cross radial fore-arm loop during coronary angiogram using trans radial approach Sengottuvelu, G. Thanikachalam, S. 2010 0 Html Add to my favorites
A successful treatment for a lesion of chronic total occlusion using a virtual 3 Fr guiding catheter Nakamura, R. Ota, K. Miyai, N. Sawanishi, T. Kinoshita, N. Matsumoto, K. 2013 0 Html Add to my favorites

A 43 year-old man was admitted due to effort related chest squeezing for 3 months. Coronary angiogram showed a total occlusion of the proximal right coronary artery (RCA) with collateral vessels from left anterior descending artery. The 5F sheathless guiding catheter was engaged into the RCA and the 3F JL3.5 catheter was inserted into left coronary artery via left radial artery for simultaneous contra lateral angiography. We advanced the wire through the lesion with 2 wire technique. Three XIENCE stents (2.5 mm x 28 mm) was inserted from distal to mid RCA, and a 3.0 mm x 15 mm XIENCE stent was inserted to proximal RCA. The final angiographic result showed well expanded stent. The treatment of chronic total occlusion could be possible even slender device by getting hold of the characteristics of the device and evaluating an objective assessment of lesion characteristics.

A technique to access difficult to find upper extremity veins for right heart catheterization: the levogram technique Pancholy, S. B. Sweeney, J. 2011 0 Html Add to my favorites

Upper extremity venous access provides a safer alternative for performance of right heart catheterization compared to femoral venous access. We describe a technique to access deep veins of the upper extremity, in patients undergoing transradial catheterization, using levophase contrast venography. This technique allows the operator to access deep veins of the upper extremity without the need for additional equipment, staff or training, using traditional basic catheterization laboratory skills and equipment.

A twist in the transradial coronary catheterisation Asrar ul Haq M, Williams P, Mutha V, Wilson AM, Barlis P 2014 0 Html Add to my favorites

The transradial approach for coronary angiography was first described in 1989. With the advent of modern equipment and improved technology it has recently gained significant interest amongst interventional cardiologists. As compared to femoral access, the radial approach has the major advantages of lower access site complication rates, cost-effectiveness, and shorter hospital stays. Further clinical benefits of lower morbidity and cardiac mortality in patients with ST-elevation myocardial infarction have been shown recently. Rare vascular complications may include radial artery spasm, dissection, occlusion, perforation or compartment syndrome. Here, we present two unusual cases of an entrapped catheter in the radial artery and their outcomes.

Aberrant right subclavian artery hematoma following radial catheterization Kassimis, G. Sabharwal, N. Patel, N. Banning, A. 2013 0 Html Add to my favorites

No abstract available

Absence of the brachial artery during transradial coronary intervention Park, C. B. Sohn, I. S. Kim, C. J. 2011 0 Html Add to my favorites

No abstract available

Access site complications and puncture site pain following transradial coronary procedures: a correlational study Cheng, K. Y. Chair, S. Y. Choi, K. C. 2013 0 Html Add to my favorites

BACKGROUND: Transradial coronary angiography (CA) and percutaneous coronary intervention (PCI) are gaining worldwide popularity due to the low incidence of major vascular complications and early mobilization of patients post procedures. Although post transradial access site complications are generally considered as minor in nature, they are not being routinely recorded in clinical settings. OBJECTIVES: To evaluate the incidence of access site complications and level of puncture site pain experienced by patients undergoing transradial coronary procedures and to examine factors associated with access site complications occurrence and puncture site pain severity. METHODS: A cross-sectional correlational study of 85 Chinese speaking adult patients scheduled for elective transradial CA and or PCI. Ecchymosis, bleeding, hematoma and radial artery occlusion (RAO) were assessed through observation, palpation and plethysmographic signal of pulse oximetry after coronary procedures. Puncture site pain was assessed with a 100mm Visual Analogue Scale. Factors that were related to access site complications and puncture site pain were obtained from medical records. RESULTS: Ecchymosis was the most commonly reported transradial access site complication in this study. Paired t-test showed that the level of puncture site pain at 24 h was significantly (p<0.001) lower than that at 3 h after the procedure. Stepwise multivariable regression showed that female gender and shorter sheath time were found to be significantly associated with bleeding during gradual deflation of compression device. Only longer sheath time was significantly associated with RAO. Female gender and larger volume of compression air were associated with the presence of ecchymosis and puncture site pain at 3 h after procedure, respectively. CONCLUSIONS: The study findings suggest that common access site complications post transradial coronary procedures among Chinese population are relatively minor in nature. Individual puncture site pain assessment during the period of hemostasis is important. Nurses should pay more attention to factors such as female gender, sheath time and volume of compression that are more likely to be associated with transradial access site complications and puncture site pain.

Access site selection for primary PCI: the evidence for transradial access is strong Ratib, K., Mamas, M. A., Routledge, H., Fraser, D., Nolan, J. 2012 0 Html Add to my favorites

No abstract available

Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins Honda, T. Fujimoto, K. Miyao, Y. Koga, H. Hirata, Y. 2012 0 Html Add to my favorites

The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P < 0.05] and BMI (OR 0.86; P < 0.01) were risk factors for bleeding complications; and sheath size (OR 5.2; P < 0.05) and the lack of statin pretreatment (OR 0.50; P < 0.05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures.

Access strategies for peripheral arterial intervention Narins C.R. 2009 0 Html Add to my favorites

An operator’s ability to determine the optimal vascular access strategy for patients undergoing peripheral endovascular intervention is critical to maximizing procedural safety and success. Individualizing an approach to access requires careful planning, and is contingent upon a solid general knowledge of normal and abnormal vascular anatomy, as well as the particulars of each patient’s history, physical examination, and non-invasive test results. An awareness of the technical nuances, relative safety, and indications for obtaining percutaneous arterial access at all potential sites is essential. Available means for approaching lower extremity arterial disease include the retrograde and antegrade common femoral approaches, the contralateral crossover technique, upper extremity approaches from the radial, brachial, or axillary arteries, or occasionally retrograde access via the popliteal, dorsalis pedis, or tibial arteries. These techniques, as well as important considerations for approaching disease of the renal, subclavian, and carotid arteries are reviewed.

Access versus non-access site bleeding and risk of subsequent mortality and MACE Mamas M - AIMRADIAL 2015 - Access vs. non-access site bleeding 10/17/2015 0 Slideshare Add to my favorites
Access-site complications and their management during transradial cardiac catheterization Bhat, T., Teli, S., Bhat, H., Akhtar, M., Meghani, M., Lafferty, J., Gala, B. 2012 0 Html Add to my favorites

Transradial access for cardiac catheterization is now widely accepted among the invasive cardiology community as a safe and viable approach with a markedly reduced incidence of major access-related complications compared with the transfemoral approach. As this access technique is now being used more commonly for cardiac catheterization, it is of paramount importance to be aware of its complications and to understand their prevention and management. Some of the common complications of transradial access include asymptomatic radial artery occlusion, nonocclusive radial artery injury and radial artery spasm. Among these complications, radial artery spasm is still a significant challenge. Symptomatic radial arterial occlusion, pseudoaneurysm and radial artery perforation are rarely reported complications of the transradial approach. Early identification of these rare complications and their immediate management is of vital importance. Arteriovenous fistula, minor nerve damage and complex regional pain syndrome are very rare but have been reported. Recently, granulomas have been reported to be associated with the use of a particular brand of hydrophilic sheaths during the procedure. Generally, access-site complications can be minimized by avoiding multiple punctures, selection of smaller sheaths, gentle catheter manipulation, adequate anticoagulation, use of appropriate compression devices and avoiding prolonged high-pressure compression. In addition, careful observation for any ominous signs such as pain, numbness and hematoma formation during and in the immediate postprocedure period is essential in the prevention of catastrophic hand ischemia.

ACCOAST: what’s new about antiplatelet therapy Montalescot G - AIMRADIAL 2013 - Prasugrel and radial 09/27/2013 0 Slideshare Add to my favorites
Achieving optimal arterial access for PCI Douglas, J. S., Jr. 2011 0 Html Add to my favorites

Achieving optimal arterial access for performance of percutaneous coronary intervention (PCI) should involve considerations of safety, efficacy, timeliness, and patient satisfaction with safety paramount. In this regard, there has been a heightened awareness of the importance of periprocedural access site bleeding due to its association with morbidity, mortality, and increased costs. In the current environment of intense scrutiny of procedural outcomes, quality monitoring and cost containment, bleeding avoidance strategies have emerged. Most notably, the pioneering works of Campeau and Kiemeneij, coupled with refinements of radial access equipment and strategy, have permitted skilled operators to perform coronary angiography and intervention radially with an almost total exclusion of major access site bleeding. However, adoption of radial access for PCI by international operators has far exceeded that of United States (US) operators. Observational and small randomized studies comparing outcomes based on access site, radial versus femoral, reported better outcomes with radial access with respect to bleeding and in some cases ischemic complications as well. These studies led to an outcry from a small but vocal cadre of radial operators urging wider adoption of radial access in the US, where fewer than 5% of PCIs are performed radially. While this conversion to use of more radial access seems highly appropriate given the potential benefits, the issue is not as simple as it appears. Not all patients are equally good candidates for radial access. Not all PCI operators have the time or volume of cases that would permit them to retrain and acquire the skill set necessary to perform PCI radially. In addition, the call-to-arms to adopt radial access is only one of several bleeding avoidance strategies that should be considered. Accessing the risk of bleeding of the individual patient is the first step toward the safest possible PCI, whether performed via radial or femoral access.

Actual outpatient PTCA: results of the OUTCLAS pilot study Slagboom T., Kiemeneij, F., Laarman, G. J., van der Wieken, R., Odekerken, D. 2001 0 Html Add to my favorites

This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Included were 159 patients treated with balloon angioplasty or intracoronary stent placement, all performed via the radial artery with 6 French guiding catheters. Patients were selected for same-day discharge based on the absence of any adverse predictor for subacute occlusion or unfavorable clinical outcome during the first 24 hr after successful PTCA. One hundred and six (66%) patients were discharged 4-6 hr after PTCA. Stents were used in 40% of patients. There were no cardiac or vascular complications. We conclude that outpatient PTCA, performed via the radial artery, is both safe and feasible in a large part of a routine PTCA population.

Acute compartment syndrome after transradial coronary angioplasty Lin Y.J., Chu, C. C., Tsai, C. W. 2004 0 Html Add to my favorites
Acute compartment syndrome in a patient after transradial access for percutaneous cardiac intervention Wang P.J., Tian, X., Zhang, Q. 2007 0 Html Add to my favorites
Acute compartment syndrome of the forearm that occurred after transradial intervention and was not caused by bleeding or hematoma formation Araki T., Itaya, H., Yamamoto, M. 2010 0 Html Add to my favorites

Recently, transradial angiography and intervention have been performed with high success rates and low rates of vascular complications. The incidence of compartment syndrome after the transradial approach seems to be very low. However, bleeding in the arm can occur and may lead to the devastating complication of compartment syndrome of the forearm, which if not treated early, can evolve into a disability of the arm. In fact, most cases of such complications are caused by guidewire- or catheter-induced damage to small arterial branches that are considerably proximal to the puncture site. However, we encountered a case of compartment syndrome that was not caused by bleeding or hematoma formation and required urgent fasciotomy for its treatment. The forearm wounds were left open to allow the edema to resolve and closed after 1 week. The patient recovered and was discharged, with full movement of his forearm and hand. We suspect that an arterial spasm induced by the radial sheath or catheter resulted in ischemia of the forearm muscles. To our knowledge, this is the first reported case in which acute compartment syndrome of the forearm occurred after transradial intervention and was not due to bleeding or hematoma formation.

Acute coronary syndrome in elderly patients: experience of Aix-en-Provence General Hospital Khachab, H. Rahal, Y. Boulain, L. Barnay, C. Morice, R. Taieb, J. Benchaa, T. Jouve, B. 2013 0 Html Add to my favorites

INTRODUCTION: Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention. METHODS AND RESULTS: To discuss these specificities, we realized a retrospective study involving patients aged more than 75years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P=0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS). DISCUSSION AND CONCLUSION: Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent.

Acute forearm muscle swelling post transradial catheterization and compartment syndrome: prevention is better than treatment! Bertrand O.F. 2010 0 Html Add to my favorites
Acute gastrointestinal bleeding after percutaneous coronary intervention Wallace, M. C. Rankin, J. Forbes, G. M. 2012 0 Html Add to my favorites

Bleeding from the GI tract is a commonly encountered clinical problem after percutaneous coronary intervention. The GI tract is likely to become the most commonly encountered site of bleeding as cardiologists adopt smaller access sheath sizes, percutaneous closure devices and a radial artery approach, further reducing access-site bleeding. To appropriately manage gastrointestinal bleeding in this setting, the clinician must strike a balance between arresting hemorrhage and preventing ischemic coronary complications. To do so, an appreciation of both cardiovascular and gastrointestinal issues is required. This review aims to provide the required knowledge, as well as a series of recommendations from our practice, to assist in the management of this potentially fatal complication.

Acute hand ischemia after radial intervention in patient with CREST-associated pulmonary hypertension: successful treatment with manual thromboaspiration Taglieri N., Galie N., Marzocchi A. 2013 0 Html Add to my favorites

We describe the case of a 60-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) associated pulmonary hypertension undergoing transradial coronary angiography. The day after the procedure, the patient complained of severe symptoms and signs of acute hand ischemia. Urgent right upper extremity angiography showed the lack of ulnar palmar arch and a severe narrowed radial artery with endoluminal filling defect. The patient was successfully treated with manual thromboaspiration leading to a complete flow restoration and symptom relief. This case shows that radial occlusion, one of the most common and usually asymptomatic complications following transradial cardiac catheterization, may cause severe hand ischemia in patients with small-vessel inflammatory disease.

Acute kidney injury – A european perspective. Comparison of risk of acute kidney injury following primary PCI with the transradial approach vs the transfemoral approach: The PRIPITENA Urban Registry Cortese B - AIMRADIAL 2014 - Acute kidney injury 10/25/2014 0 Slideshare Add to my favorites
Acute kidney injury: US perspective Gilchrist IC - AIMRADIAL 2014 - Acute kidney injury 10/25/2014 0 Slideshare Add to my favorites
Acute Myocardial Infarction and Transradial Approach Ludwig J 2011 0 Slideshare Add to my favorites
Acute myocardial infarction during pregnancy: A clinical checkmate Jaiswal, A. Rashid, M. Balek, M. Park, C. 2013 0 Html Add to my favorites

Acute myocardial infarction (AMI) in pregnancy is associated with high morbidity and mortality. Management of these patients can be challenging as little is known about the optimal management strategy. Medications routinely used may have harmful effects on the pregnancy outcome. In addition, AMI could occur in the absence of atherosclerotic disease. We describe optimal management strategy by eliciting the management of a 45-year-old female with ST segment elevation myocardial infarction. We recommend early use of coronary angiography to define the pathology in such cases. Radial artery assess should be preferred. Pregnant patients with AMI due to atherosclerotic disease should be given a 325 mg of aspirin and 600 mg of clopidogrel and either balloon angioplasty or bare metal stent should be used for revascularization. Percutaneous coronary intervention with heparin is preferred over bivalirudin and later should be reserved for patients with severe heparin allergy.

Acute myocardial infarction in a patient with Behcet’s disease Beyranvand M.R., Namazi, M. H., Mohsenzadeh, Y., Assadpour Piranfar, M. 2009 0 Html Add to my favorites

A 37-year-old man, a known case of Behcet’s disease with its vascular complications such as abdominal and thoracic artery aneurysms, was admitted with the diagnosis of acute anterior myocardial infarction and received thrombolytic therapy. Coronary angiography and percutaneous coronary intervention via transradial approach were performed for the patient on the eighth day of admission. The patient did not suffer from any symptoms, myocardial infarction, or readmission in the nine-month follow-up. About 25 cases of myocardial infarction associated with Behcet’s disease have been reported previously. Although coronary involvement is rare in Behcet’s disease, it is especially important because it affects young individuals and often presents as acute coronary syndromes.

Acute myocardial infarction in elderly patients: feasibility of transradial intervention and rapid mobilization Kagoshima M. 2000 0 Html Add to my favorites

OBJECTIVES: Rapid mobilization and discharge following rapid acute phase reperfusion are recommended for elderly patients with acute myocardial infarction to achieve a better outcome and performance. The safety and efficacy of new and old treatment protocols were retrospectively compared for patients with acute myocardial infarction. METHODS: The new protocol used transradial intervention, encouraged stent implantation, beta-blocker administration, and rapid mobilization for rapid discharge (10-14 day hospital stay). The previous protocol used transfemoral intervention, bed rest and late mobilization, and discouraged stent implantation and beta-blocker supplementation. High risk patients with cardiogenic shock, left main disease, malignant arrhythmia and impending myocardial rupture were excluded from the study. RESULTS: Thirty-two patients were treated by the new protocol, and 57 patients by the old protocol. The former included more elderly patients (p < 0.05). The prevalence of beta-blocker use (63.3% vs 18.8%, p < 0.001) and stent implantation (43.8% vs 3.5%, p < 0.05) were higher in the new protocol group. Hospital stay (23.6 +/- 9.5 vs 13.3 +/- 5.9 days, p < 0.001) and intensive care unit stay (4.4 +/- 3.0 vs 2.4 +/- 1.2 days, p < 0.001) were shorter in the new protocol than in the old protocol group. Rates of in-hospital death, cardiac events, systemic complications and left ventricular function (left ventricular ejection fraction and left ventricular end-diastolic volume index at admission and discharge) were not significantly different between the 2 groups. The prevalence of systemic complications (including delirium) among patients older than 70 years was lower in the new protocol group (4.7% vs 11.7%, p < 0.05). CONCLUSIONS: The new protocol can shorten hospital stay with no increase in in-hospital death or cardiac events, or decline of left ventricular function. Moreover, the new protocol is potentially effective for reducing systemic complications among elderly patients. Therefore, this protocol can be recommended for elderly patients with acute myocardial infarction.

Ad hoc PCI via the transradial approach: how to achieve success Kirtane AJ 2013 06 06/30/2014 0 Slideshare Add to my favorites
Ad hoc transradial coronary angioplasty strategy: experience and results in a single centre Galli M., Di Tano, G., Mameli, S., Butti, E., Politi, A., Zerboni, S., Ferrari, G. 2003 0 Html Add to my favorites

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.

Adjusted weight anticoagulation for radial approach in elective coronarography: the AWARE coronarography study Schiano P., Barbou, F., Chenilleau, M. C., Louembe, J., Monsegu, J. 2010 0 Html Add to my favorites

AIMS: To evaluate the feasibility and safety of an anticoagulation adapted regimen for transradial coronary angiography. METHODS AND RESULTS: We randomly assigned 162 consecutive patients who benefited from an elective transradial approach for coronarography to receive either a standard dose of 5,000 IU heparin or 50 IU/kg with an upper limit of 5,000 IU. Patients under anti-vitamin K therapy were excluded. The TRband compression system was employed for the entire population after the procedure. Radial artery patency, the primary endpoint, was evaluated with Doppler before discharge from the hospital. Secondary endpoints were: ACT level immediately before sheath removal, compression length and bleeding complications. Both groups were well matched. ACT level is significantly lower in the adjusted anticoagulation group (231.4 min, vs. 265.6 min, p<10-4). Radial compression time was higher in the standard protocol group (235.5 min, vs. 204.5 min, p<10-5). No radial occlusion was noted, whatever the group considered. Local haematoma is less frequent in the 50 IU/kg group, with no statistical difference. CONCLUSIONS: A weight-adjusted heparin dose allows for lower ACT levels and decreases in radial compression time without increase in radial artery occlusion. The impact on bleeding complication needs further evaluation in larger series.

Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012) Feldman, D. N., Swaminathan, R. V., Kaltenbach, L. A., Baklanov, D. V., Kim, L. K., Wong, S. C., Minutello, R. M., Messenger, J. C., Moussa, I., Garratt, K. N., Piana, R. N., Hillegass, W. B., Cohen, M. G., Gilchrist, I. C., Rao, S. V. 2013 0 Html Add to my favorites

BACKGROUND: Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. METHODS AND RESULTS: We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age >/=75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49-0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31-0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. CONCLUSIONS: There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.

Adoption of transradial percutaneous coronary intervention and outcomes according to center radial volume in the Veterans Affairs Healthcare system: insights from the Veterans Affairs clinical assessment, reporting, and tracking (CART) program Gutierrez, A. Tsai, T. T. Stanislawski, M. A. Vidovich, M. Bryson, C. L. Bhatt, D. L. Grunwald, G. K. Rumsfeld, J. Rao, S. V. 2013 0 Html Add to my favorites

BACKGROUND: Studies examining the association between radial approach and post-percutaneous coronary intervention (PCI) bleeding and mortality have reached conflicting conclusions. There are no current data about the use and outcomes of transradial PCI (r-PCI) in the Veterans Affairs system. METHODS AND RESULTS: Consecutive veterans (n=24143 patients) undergoing PCI in the Veterans Affairs between 2007 and 2010 were examined. On the basis of propensity to undergo r-PCI, 3 cohorts matched with veterans undergoing transfemoral access were constructed among sites performing >/= 1 r-PCI, >/= 50 r-PCI (high volume), and <50 r-PCI (low volume). Cox proportional hazard models were used to determine the association between PCI access site, blood transfusion, and mortality. The prevalence of r-PCI increased over time (2007=2.1%; 2010=8.8%). Overall, there was no difference in procedure success between matched groups (r-PCI 97.3% versus transfemoral PCI 96.6%; P=0.182), or in the risk of postprocedure transfusion or mortality. Among matched patients treated at high r-PCI volume sites, radial access was associated with a decreased risk of post-PCI blood transfusion (hazard ratio, 0.4; 95% confidence interval, 0.3-0.7; P<0.001), and no significant difference in the risk of mortality (hazard ratio, 0.7; 95% confidence interval, 0.4-1.3; P=0.279). CONCLUSIONS: Within the Veterans Affairs, the use of r-PCI increased over time. r-PCI may be associated with a significant decreased risk of post-PCI blood transfusion among higher volume r-PCI sites. These data demonstrate that potential benefits of r-PCI in terms of reduced post-PCI blood transfusions may be more pronounced at sites that routinely use radial access.

Advantages and concerns regarding transradial cardiac catheterization Nibber A, Whayne TF, Jr 2014 0 Html Add to my favorites

No abstract available

Adverse event rates following primary PCI for STEMI at US and non-US hospitals: three-year analysis from the HORIZONS-AMI trial Tobbia, P. Brodie, B. R. Witzenbichler, B. Metzger, C. Guagliumi, G. Yu, J. Kellett, M. A. Stuckey, T. Fahy, M. Mehran, R. Stone, G. W. 2013 0 Html Add to my favorites

AIMS: To examine outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) at US sites versus sites outside the US (OUS). METHODS AND RESULTS: In the HORIZONS-AMI trial 3,602 STEMI patients in 11 countries were randomised to primary PCI with bivalirudin versus heparin + glycoprotein IIb/IIIa inhibitors. US patients (n=814) had more diabetes, prior infarction, prior bypass surgery, and renal insufficiency. OUS patients (n=2,788) had longer door-to-balloon times, more radial access, fewer bypass surgeries, and were discharged more often on beta-blockers and statins. At three years US patients had higher mortality (9.7% vs. 6.0%, p=0.0003), reinfarction (10.2% vs. 6.4%, p=0.001), major adverse cardiac events (MACE; 28.2% vs. 20.1%, p<0.0001), major bleeding (16.9% vs. 6.4%, p<0.0001) and net adverse clinical events (NACE; 36.6% vs. 23.8%, p<0.0001), which persisted after adjusting for baseline risk. CONCLUSIONS: In the HORIZONS-AMI trial, STEMI patients undergoing primary PCI at US versus OUS sites had higher rates of adverse events, which persisted after adjusting for baseline risk. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care and treatments.

Adverse local reactions to the use of hydrophilic sheaths for radial artery canulation Tharmaratnam D., Webber, S., Owens, P. 2010 0 Html Add to my favorites

There have been reports of local sterile inflammatory reactions with the use of Cook hydrophilic-coated sheaths (HCS) for transradial coronary angiography/intervention. Our aim was to gauge the extent of radial artery access site complications following radial artery canulation and to compare the incidence of such complications with HCS versus non-coated sheaths in our hospital. We undertook a retrospective questionnaire-based postal study, receiving replies from 1283 patients who had transradial coronary angiography/percutaneous coronary intervention in our institution between Feb 2005 and Oct 2006. HCS had been used in 856 of these patients. Patients reported adverse local reactions at the access site in 12.9% of cases, including pain (57.2%), swelling (27.7%) and non-specific sensory abnormalities (13.2%). A total of 5.0% of patients sought medical help for their problem, mainly (78.1%) from their general practitioner. The use of a HCS compared to a non-coated sheath was associated with a significant excess of patient-reported adverse reactions (14.6% vs. 9.6%, p=0.015). A logistic regression analysis confirmed that the use of a hydrophilic sheath (OR 1.5, (1.05-2.26)) and female gender (OR 1.9, (1.4-2.8)), were independent predictors of self-reported adverse outcomes after controlling for possible confounders.

Aggressive diagnostic and therapeutic approach for acute coronary syndrome Ochiai M., Yokoyama, N., Eto, K., Oshima, A., Koyama, Y., Takeshita, S., Isshiki, T., Sato, T. 1999 0 Html Add to my favorites

The purpose of this article is to propose an “aggressive strategy” in the treatment of patients with acute coronary syndrome (ACS), especially unstable angina. The indication and timing of emergent coronary angiography in patients with ACS remains to be validated. The results of TIMI III B trial, a randomized, controlled trial about this issue, show that an early invasive strategy reduced the average length of initial hospitalization and the incidence of rehospitalization within 6 weeks. However, the same kind of clinical trial named VANQWISH reported that no benefit was obtained from such an aggressive strategy. It is of paramount importance to note that these 2 studies were performed in the era of plain old balloon angioplasty. Now we can use many kinds of coronary stent which impart both excellent radial strength and flexibility. Recent studies have demonstrated that culprit lesions of ACS can be treated at the same success rate as those of stable effort angina. In our hospital, use of coronary stents in patients with ACS dramatically reduced the recurrence of ACS and the incidence of angiographic restenosis with the same initial procedure success rate. Since the mid-nineties, the radial artery has been used as a vascular access site of coronary intervention. The major advantage of this technique is lesser access site-related complications and increased patient comfort, which reduced hospital stay and cost. Recently it was demonstrated that ad-hoc transradial intervention can be applied in patients with unstable angina or even those with acute myocardial infarction by trained angioplasters. Thus, we would like to conclude that the best strategy in the management of ACS is to perform emergent coronary angiography from the radial artery as soon as possible after admission, and to do ad-hoc intervention using coronary stents suitable for the lesion anatomy.

All in favor of radial percutaneous coronary intervention, raise your (patient’s) hand Bailey S.R. 2010 0 Html Add to my favorites
All roads (even those less traveled) lead to rome benefits of transradial coronary interventions Chen J.P. 2010 0 Html Add to my favorites
Ambulatory discharge after transradial coronary intervention: Preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study) Jabara R., Gadesam, R., Pendyala, L., Chronos, N., Crisco, L. V., King, S. B., Chen, J. P. 2008 0 Html Add to my favorites

BACKGROUND: Although the safety and cost-effectiveness of same-day discharge after uncomplicated transradial percutaneous coronary intervention (TR-PCI) is well established in Europe and Asia, such data are not available for US patients. METHODS: All patients who underwent TR-PCI at our high-volume US medical center between 2004 and 2007 were included in this study. The primary end point was in-hospital adverse clinical outcomes between 6 and 24 hours postprocedure. RESULTS: A total of 450 patients were included in this study (aged 59 +/- 11 years). Of these, 13% were female, 27% were diabetic, 6% had peripheral vascular disease, and 5% had chronic kidney disease. Procedural indications included stable angina (49%), unstable angina (31%), non-ST elevation myocardial infarction (NSTEMI) (17%), and ST elevation myocardial infarction (STEMI) (3%). All patients received an intra-arterial cocktail of heparin, verapamil, and nitroglycerin, and 13% of patients received glycoprotein IIb/IIIa inhibitors. Seven percent of patients had 3-vessel disease, 3% had bypass grafts stenoses, and 20% had class B(2)/C lesions. Procedural success rate was 96%. A total of 24 (5.3%) postprocedural complications were observed,however, none occurred between hours 6 to 24, the time differential between same-day and next-day discharge. Thirteen patients (2.9%) experienced significant complications within the first 6 hours (MI, urgent repeat revascularization, and ventricular tachycardia). Eleven (2.4%) spontaneously resolved minor access complications developed. There were 12 same-day discharges according to the operators’ discretion,none required readmission. CONCLUSIONS: Although a low incidence of complications did occur, none would have been impacted by same-day discharge. Those observed before 6 hours would have prevented early discharge, and those occurring after 24 hours would have been unaffected by routine next-day discharge. This observational study demonstrated the safety and feasibility for a prospective evaluation of ambulatory TR-PCI in an American practice setting.

Ambulatory transradial angioplasty in Mexico: is it possible? Perez-Alva J.C., Escarcega, R. O. 2008 0 Html Add to my favorites
Ambulatory transradial percutaneous coronary intervention: a safe, effective, and cost-saving strategy Le Corvoisier, P. Gellen, B. Lesault, P. F. Cohen, R. Champagne, S. Duval, A. M. Montalescot, G. Elhadad, S. Montagne, O. Durand-Zaleski, I. Dubois-Rande, J. L. Teiger, E. 2013 0 Html Add to my favorites

OBJECTIVES: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. Background: Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. METHODS: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI. RESULTS: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 +/- 98 Euros vs. 2,304 +/- 1814 Euros, P < 10(-6)). CONCLUSIONS: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization.

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